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Akinrolie O, Iwuagwu AO, Kalu ME, Rayner D, Oyinlola O, Ezulike CD, Okoh AC, Makanju AO, Ugwuodo EP, Ugwuja IA, John MO, Adeleke D, Egbumike CJ, Anieto EM, Anieto IB, Alumona CJ, Onyeso OK, Ojembe B, Omeje CA, Nwachukwu EC, Ekediegwu EC, Onyeso KM, Adeboye A, Ibekaku M, Akinrolie O, Onyekere CP. Longitudinal Studies of Aging in Sub-Saharan Africa: Review, Limitations, and Recommendations in Preparation of Projected Aging Population. Innov Aging 2024; 8:igae002. [PMID: 38628825 PMCID: PMC11020233 DOI: 10.1093/geroni/igae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Indexed: 04/19/2024] Open
Abstract
Background and Objectives The United Nations has projected a 218% increase in older people in Sub-Saharan Africa (SSA) between 2019 and 2050, underscoring the need to explore changes that would occur over this time. Longitudinal studies are ideal for studying and proffering solutions to these changes. This review aims to understand the breadth and use of longitudinal studies on aging in the SSA regions, proffering recommendations in preparation for the projected aging population. Research Design and Methods This paper is the third of a four-part series paper of a previous systematic mapping review of aging studies in SSA. We updated the search (between 2021 and 2023) and screened the titles/abstracts and full-text articles by a pair of independent reviewers. Data were extracted using a standardized data-charting form, identifying longitudinal studies in SSA. Results We identified 193 studies leveraging 24 longitudinal study data sets conducted at 28 unique sites. The World Health Organization's Study on Global AGEing and Adult Health (WHO-SAGE) (n = 59, 30.5%) and Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (n = 51, 26.4%) were the most used longitudinal data sets. Four studies used more than one longitudinal study data set. Eighteen of the longitudinal study data sets were used only in 1-4 studies. Most (n = 150, 77.7%) of the studies used a cross-sectional analytical approach. Discussion and Implications Longitudinal studies on aging are sparingly being utilized in SSA. Most analyses conducted across the longitudinal data set were cross-sectional, which hindered the understanding of aging changes that occurred over time that could better inform aging policy and interventions. We call for funding bodies, such as WHO-SAGE, to develop funding competitions that focus on conducting longitudinal analyses, such as structural equation modeling, highlighting changes occurring among the aging population in SSA.
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Affiliation(s)
- Olayinka Akinrolie
- Applied Health Sciences, Faculty of Graduate Studies, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony O Iwuagwu
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Department of Social Work, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Michael E Kalu
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Daniel Rayner
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Oluwagbemiga Oyinlola
- School of Social Work, McGill University, Montreal, Quebec, Canada
- Medical Social Services Department, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Chigozie D Ezulike
- Department of Social Work, University of Nigeria, Nsukka, Enugu State, Nigeria
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Augustine C Okoh
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adebayo O Makanju
- Interdisciplinary Social Research Program (Aging and Health), Trent University, Peterborough, Ontario, Canada
| | - Ebere P Ugwuodo
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Immaculata A Ugwuja
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | | | - Deborah Adeleke
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Ijeoma B Anieto
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Chiedozie James Alumona
- Department of Physiotherapy, College of Basic Medical Sciences, Chrisland University, Abeokuta, Ogun State, Nigeria
- Faculty of Health Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | | | - Blessing Ojembe
- Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chidinma A Omeje
- Physiotherapy Unit, Asaba Specialist Hospital, Asaba, Delta State, Nigeria
| | - Ernest C Nwachukwu
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ezinne C Ekediegwu
- Department of Medical Rehabilitation (Physiotherapy), Faculty of Health Sciences and Technology, Nnamdi Azikwe University, Nnewi Campus, Anambra, Nigeria
| | - Kelechi M Onyeso
- Department of Estate Management, Faculty of Environmental Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Ademuyiwa Adeboye
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Michael Ibekaku
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Omobolade Akinrolie
- Department of Obstetrics and Gynecology, Health Science Centre, Winnipeg, Manitoba, Canada
| | - Chukwuebuka P Onyekere
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, UK
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria, Nsukka, Enugu State, Nigeria
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Beidelman ET, Rosenberg M, Wade AN, Crowther NJ, Kalbaugh CA. Prevalence of and Risk Factors for Peripheral Artery Disease in Rural South Africa: A Cross-Sectional Analysis of the HAALSI Cohort. J Am Heart Assoc 2024; 13:e031780. [PMID: 38156447 PMCID: PMC10863815 DOI: 10.1161/jaha.123.031780] [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: 07/14/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The burden of peripheral artery disease (PAD) is increasing in low- and middle-income countries. Existing literature from sub-Saharan Africa is limited and lacks population-representative estimates. We estimated the burden and risk factor profile of PAD for a rural South African population. METHODS AND RESULTS We used data from 1883 participants from a rural, low-income cohort of South African adults aged 40 to 69 years with available ankle-brachial index measurements. We defined clinical PAD as ankle-brachial index ≤0.90 or >1.40, and borderline PAD as ankle-brachial index >0.90 and ≤1.00. We compared the distribution of sociodemographic variables, biomarkers, and comorbidities across PAD classifications. To identify associated factors, we calculated unadjusted and age-sex-adjusted prevalence ratios (PRs) with log-binomial models. Overall, 6.6% (95% CI, 5.6-7.7) of the sample met the diagnostic criteria for clinical PAD, while 44.7% (95% CI, 42.4-47.0) met the diagnostic criteria for borderline PAD. Age (PR: 1.9 [95% CI, 1.2-3.1] for ages 50-59 years compared with 40-49 years; PR: 2.5 [95% CI, 1.5-4.0] for ages 60-69 years compared with 40-49 years); diagnosed hypertension (PR: 1.53 [95% CI, 1.08-2.17]); and C-reactive protein (PR: 1.08 [95% CI, 1.03-1.12]) were associated with increased prevalence of clinical PAD. All other examined factors were not significantly associated with clinical PAD. CONCLUSIONS We found high PAD prevalence for younger age groups compared with previous research and a lack of statistical evidence for the influence of traditional risk factors for this rural, low-income population. Future research should focus on identifying the underlying risk factors for PAD in this setting. South African policymakers and clinicians should consider expanded screening for early PAD detection in rural areas.
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Affiliation(s)
- Erika Teresa Beidelman
- Department of Epidemiology and BiostatisticsIndiana University Bloomington School of Public HealthBloomingtonINUSA
| | - Molly Rosenberg
- Department of Epidemiology and BiostatisticsIndiana University Bloomington School of Public HealthBloomingtonINUSA
| | - Alisha N. Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public HealthUniversity of the Witwatersrand Johannesburg, South Africa Faculty of Health SciencesJohannesburgSouth Africa
- Division of Endocrinology, Diabetes and MetabolismPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPAUSA
| | - Nigel J. Crowther
- Department of Chemical PathologyNational Health Laboratory Service, University of the Witwatersrand Johannesburg Faculty of Health SciencesJohannesburgSouth Africa
| | - Corey A. Kalbaugh
- Department of Epidemiology and BiostatisticsIndiana University Bloomington School of Public HealthBloomingtonINUSA
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Abrahams-Gessel S, Gómez-Olivé FX, Tollman S, Wade AN, Du Toit JD, Ferro EG, Kabudula CW, Gaziano TA. Improvements in Hypertension Control in the Rural Longitudinal HAALSI Cohort of South African Adults Aged 40 and Older, From 2014 to 2019. Am J Hypertens 2023; 36:324-332. [PMID: 36857463 PMCID: PMC10200554 DOI: 10.1093/ajh/hpad018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/26/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Over half of the South African adults aged 45 years and older have hypertension but its effective management along the treatment cascade (awareness, treatment, and control) remains poorly understood. METHODS We compared the prevalence of all stages of the hypertension treatment cascade in the rural HAALSI cohort of older adults at baseline and after four years of follow-up using household surveys and blood pressure data. Hypertension was a mean systolic blood pressure >140 mm Hg or diastolic pressure >90 mm Hg, or current use of anti-hypertension medication. Control was a mean blood pressure <140/90 mm Hg. The effects of sex and age on the treatment cascade at follow-up were assessed. Multivariate Poisson regression models were used to estimate prevalence ratios along the treatment cascade at follow-up. RESULTS Prevalence along the treatment cascade increased from baseline (B) to follow-up (F): awareness (64.4% vs. 83.6%), treatment (49.7% vs. 73.9%), and control (22.8% vs. 41.3%). At both time points, women had higher levels of awareness (B: 70.5% vs. 56.3%; F: 88.1% vs. 76.7%), treatment (B: 55.9% vs. 41.55; F: 79.9% vs. 64.7%), and control (B: 26.5% vs. 17.9%; F: 44.8% vs. 35.7%). Prevalence along the cascade increased linearly with age for everyone. Predictors of awareness included being female, elderly, or visiting a primary health clinic three times in the previous 3 months, and the latter two also predicted hypertension control. CONCLUSIONS There were significant improvements in awareness, treatment, and control of hypertension from baseline to follow-up and women fared better at all stages, at both time points.
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Affiliation(s)
- Shafika Abrahams-Gessel
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - F Xavier Gómez-Olivé
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Alisha N Wade
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques D Du Toit
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Enrico G Ferro
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Chodziwadziwa W Kabudula
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas A Gaziano
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
- Cardiovascular Medicine Division, Brigham & Women’s Hospital, Boston, Massachusetts, USA
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Fernández LG, Firima E, Robinson E, Ursprung F, Huber J, Amstutz A, Gupta R, Gerber F, Mokhohlane J, Lejone T, Ayakaka I, Xu H, Labhardt ND. Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: a literature scoping review and framework for designing chronic services. BMC Public Health 2022; 22:1126. [PMID: 35658850 PMCID: PMC9167524 DOI: 10.1186/s12889-022-13467-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background Arterial hypertension (aHT) is the leading cardiovascular disease (CVD) risk factor in sub-Saharan Africa; it remains, however, underdiagnosed, and undertreated. Community-based care services could potentially expand access to aHT diagnosis and treatment in underserved communities. In this scoping review, we catalogued, described, and appraised community-based care models for aHT in sub-Saharan Africa, considering their acceptability, engagement in care and clinical outcomes. Additionally, we developed a framework to design and describe service delivery models for long-term aHT care. Methods We searched relevant references in Embase Elsevier, MEDLINE Ovid, CINAHL EBSCOhost and Scopus. Included studies described models where substantial care occurred outside a formal health facility and reported on acceptability, blood pressure (BP) control, engagement in care, or end-organ damage. We summarized the interventions’ characteristics, effectiveness, and evaluated the quality of included studies. Considering the common integrating elements of aHT care services, we conceptualized a general framework to guide the design of service models for aHT. Results We identified 18,695 records, screened 4,954 and included twelve studies. Four types of aHT care models were identified: services provided at community pharmacies, out-of-facility, household services, and aHT treatment groups. Two studies reported on acceptability, eleven on BP control, ten on engagement in care and one on end-organ damage. Most studies reported significant reductions in BP values and improved access to comprehensive CVDs services through task-sharing. Major reported shortcomings included high attrition rates and their nature as parallel, non-integrated models of care. The overall quality of the studies was low, with high risk of bias, and most of the studies did not include comparisons with routine facility-based care. Conclusions The overall quality of available evidence on community-based aHT care is low. Published models of care are very heterogeneous and available evidence is insufficient to recommend or refute further scale up in sub-Sahara Africa. We propose that future projects and studies implementing and assessing community-based models for aHT care are designed and described according to six building blocks: providers, target groups, components, location, time of service delivery, and their use of information systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13467-4.
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Jardim TV, Witham MD, Abrahams-Gessel S, Gómez-Olivé FX, Tollman S, Berkman L, Gaziano TA. Cardiovascular Disease Profile of the Oldest Adults in Rural South Africa: Data from the HAALSI Study (Health and Aging in Africa: Longitudinal Studies of INDEPTH Communities). J Am Geriatr Soc 2018; 66:2151-2157. [PMID: 30312474 DOI: 10.1111/jgs.15567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize the cardiovascular disease (CVD) profile of individuals aged 80 and older in rural South Africa. DESIGN First wave of population-based longitudinal cohort. SETTING Agincourt subdistrict (Mpumalanga Province) in rural South Africa. PARTICIPANTS Adults residents (N = 5,059). MEASUREMENTS In-person interviews were conducted to obtain social, behavioral, economic, and clinical data. Prevalence of hypertension, diabetes, dyslipidemia, high waist-to-hip ratio, overweight and obesity, high-risk high-sensitivity C-reactive protein, smoking, stroke, myocardial infarction, angina pectoris, and heart failure in individuals younger than 65, aged 65 to 79, and aged 80 and older were compared. Associations between self-reported treatments and determinants of hypertension treatment in those aged 80 and older were assessed using multivariable regression. RESULTS Of 5,059 individuals included, 549 (10.8%) were aged 80 and older, and their CVD prevalence was 17.9% (stroke 3.8%, myocardial infarction 0.5%, angina pectoris 13.5%, heart failure 0.7%). Hypertension prevalence in this group was 73.8%, and along with angina pectoris, it increased with age (p<.001), whereas overweight and obesity (46.4%), dyslipidemia (39.1%), and smoking prevalences (3.1%) decreased (p<.001). Hypertension treatment was significantly associated with being aged 80 and older (odds ratio (OR)=1.48; 95% confidence interval (CI)=1.14-1.92, p=.003). Male sex (OR=0.73, 95% CI=0.66-0.88, p=.001), being an immigrant (OR=0.80, 95% CI=0.65-0.98; p=.03), higher socioeconomic status (OR=1.28, 95% CI=1.06-1.53, p=.009), and higher depression score (OR=1.12, 95% CI=1.05-1.19, p<.001) were associated with hypertension treatment in those aged 80 and older. CONCLUSION This is the first study to characterize the CVD profile of individuals aged 80 and older in sub-Saharan Africa and provides baseline data for comparison with future studies in this rapidly growing age group. J Am Geriatr Soc 66:2151-2157, 2018.
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Affiliation(s)
- Thiago Veiga Jardim
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Health Decision Science, T.H. Chan School of Public Health, Harvard University Boston, Massachusetts
| | - Miles D Witham
- Ageing and Health, School of Medicine, University of Dundee, Scotland, United Kingdom
| | - Shafika Abrahams-Gessel
- Center for Health Decision Science, T.H. Chan School of Public Health, Harvard University Boston, Massachusetts
| | - F Xavier Gómez-Olivé
- Medical Research Council.,Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Center for Population and Development Studies, T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
| | - Stephen Tollman
- Medical Research Council.,Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Center for Population and Development Studies, T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts.,INDEPTH Network, Accra, Ghana
| | - Lisa Berkman
- Center for Population and Development Studies, T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
| | - Thomas A Gaziano
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Health Decision Science, T.H. Chan School of Public Health, Harvard University Boston, Massachusetts
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Self-rated health status and illiteracy as death predictors in a Brazilian cohort. PLoS One 2018; 13:e0200501. [PMID: 30001429 PMCID: PMC6042772 DOI: 10.1371/journal.pone.0200501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Abstract
Cohort studies assessing predictive values of self-rated health (SRH) and illiteracy on mortality in low-to-middle income countries are missing in the literature. Aiming to determine if these two variables were death predictors, an observational prospective population-based cohort study was conducted in a Brazilian small city. The cohort was established in 2002 with a representative sample of adults living in the city, and re-assessed in 2015. Sociodemographic (including illiteracy), anthropometric, lifestyle, previous CVD, and SRH data were collected. Cox proportional hazard models were designed to assess SRH and illiteracy in 2002 as death (all causes, CVD and non-CVD) predictors in 2015. From a total of 1066 individuals included in this study, 95(9%) died of non-CVD causes and 53(5%) from CVD causes. Mortality rates were higher among those with worse SRH in comparison to better health status categories for all causes of death, CVD and non-CVD deaths (p<0.001 for all outcomes). Similarly, illiterate individuals had higher mortality rates in comparison to non-illiterate for all causes of death (p<0.001), CVD (p = 0.004) and non-CVD death (p<0.001). Higher SRH negatively predicted CVD death (HR 0.44; 95%CI 0.44–0.95; p = 0.027) and all causes of death (OR 0.40; 95%CI 0.20–0.78; p = 0.008) while illiteracy positively predicted Non-CVD death (OR 1.59; 95%CI 1.03–2.54; p = 0.046). In conclusion, we found in this large Brazilian cohort followed for 13 years that better health perception was a negative predictor of death from all causes and CVD deaths, while illiteracy was a positive predictor of non-CVD deaths.
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