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Su Y, He H, Yang J, Liu Y, Jiang W, Li C, Wei Y, Cheng J, Chen Y. Trends by age and sex and projections of disease prevalence from studying hypertensive heart disease in China over the past three decades. Int J Health Plann Manage 2024; 39:1113-1130. [PMID: 38383980 DOI: 10.1002/hpm.3786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Hypertensive heart disease (HHD) is a common cause of cardiovascular disease and mortality worldwide, and its burden is increasing with aging populations. OBJECTIVES This study aimed to estimate the prevalence and mortality rates of HHD in mainland China and Taiwan Province using data from the Global Burden of Disease Study 2019 (GBD 2019), and forecast the development trend of HHD from 2020 to 2024. METHODS We obtained data on number of cases, deaths, crude prevalence rate, crude death rate, age-standardized prevalence rate (ASPR), and age-standardized death rate (ASDR) for mainland China and Taiwan Province from 1990 to 2019 from the GBD 2019. Joinpoint software was used to estimate average annual percentage change (AAPC) with 95% confidence intervals, and the number of HHD cases in China from 2022 to 2024 was predicted by the exponential smoothing method. RESULTS Between 1990 and 2019, HHD cases and deaths increased in mainland China, but the ASPR and ASDR decreased by 5.96% and 48.72%, respectively. In Taiwan Province, ASPR and ASDR decreased by 7.66% and 52.14%, respectively. The number of HHD cases and death rates varied by region, age, and sex, with a higher number of cases in mainland China than in Taiwan Province. By 2024, the number of HHD cases in mainland China was projected to be over 9.6 million cases, and in Taiwan Province, it was projected to surpass 120,000 cases. CONCLUSION The differences in HHD cases between mainland China and Taiwan Province in terms of age and sex indicated the need for effective prevention and control measures, especially targeting the elderly population. These findings can inform policymakers and health professionals in the development of targeted prevention and treatment strategies and resource allocation for HHD in China.
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Affiliation(s)
- Yao Su
- Department of Cardiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Honghong He
- Department of Cardiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Jingtao Yang
- Department of Cardiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Ya Liu
- Department of Cardiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Weiwei Jiang
- Department of Cardiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Chen Li
- Department of Cardiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Yang Wei
- Department of Cardiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Jun Cheng
- Department of Cardiology, The People's Hospital of Yubei District of Chongqing, Chongqing, China
| | - Yiguo Chen
- Department of Orthopedics, The People's Hospital of Yubei District of Chongqing, Chongqing, China
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Chen A, Mocumbi AO, Ojji DB, Waite L, Chan YK, Beilby J, Celermajer DS, Nkeh-Chungag BN, Damasceno A, Codde J, Stewart S. Projected burden and distribution of elevated blood pressure levels and its consequence among adolescents in sub-Saharan Africa. J Glob Health 2024; 14:04136. [PMID: 38940275 PMCID: PMC11212112 DOI: 10.7189/jogh.14.04136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background There is minimal data on the number of adolescents in sub-Saharan Africa (SSA) with elevated blood pressure (BP) at increased risk of future cardiovascular events. Combining country-specific population data with data derived from two previously conducted meta-analyses (one African-specific, one based on international cohorts), we sought to address this knowledge deficit. Methods We used meta-analysis data from 37 926 adolescents participating in 36 contemporary SSA studies to generate sex-specific proportions of adolescents aged 10-14 and 15-19 years with elevated BP. The estimates were applied to the 2021 World Bank population data for each country in SSA. We then applied the rate of cardiovascular events attributable to elevated BP levels, derived from a meta-analysis of 17 observational, longitudinal cohort studies comprising 4.5 million young adults (non-African), to determine the excess number of cardiovascular events linked to hypertension among those aged 15-19 years transitioning to adulthood. Results The estimated prevalence of elevated BP among male and female adolescents aged 10-14 years living in SSA was 7.2% (95% confidence interval (CI) = 4.9-9.9) and 6.9% (95% CI = 4.7-9.5), respectively, which increased to 13.0% (95% CI = 10.6-15.6) and 12.5% (95% CI = 10.4-15.3) among male and female adolescents aged 15-19 years, respectively. Consequently, we estimate that 13.6/138.0 million (95% CI = 10.4-17.3) male and 12.9/135.7 million (95% CI = 9.83-16.3) female adolescents living in SSA have elevated BP. Among the estimated 16.1 million adolescents aged 15-19 years with elevated BP approaching adulthood, the projected excess in cardiovascular events attributable to hypertension (vs normotension) is 201 000 (95% CI = 115 000-322 000) to 503 000 (95% CI = 286 000-805 000) over the next 10-25 years. Conclusions Based on the best available data, we estimate that 26.5 million adolescents living in SSA have elevated BP. If left undetected and untreated among those approaching adulthood (those aged 15-19 years), they will experience >0.5 million excess cardiovascular events associated with persistently elevated BP within the next 25 years. Registration PROSPERO: CRD42022297948.
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Affiliation(s)
- Alexander Chen
- Torrens University Australia, Adelaide, South Australia, Australia
| | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Dike B Ojji
- University of Abuja, Abuja, Nigeria
- University of Cape Town, Cape Town, South Africa
| | - Laura Waite
- South Eastern Melbourne Primary Health Network Australia, Victorian Department of Health, Melbourne, Victoria, Australia
| | - Yih-Kai Chan
- Australian Catholic University, Melbourne, Victoria, Australia
| | - Justin Beilby
- Torrens University Australia, Adelaide, South Australia, Australia
| | | | | | - Albertino Damasceno
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Simon Stewart
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Marracuene, Mozambique
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Ibro SA, Kasim AZ, Seid SS, Abdusemed KA, Senbiro IA, Waga SS, Abamecha F, Azalework HG, Soboka M, Gebresilassie A, Tesfaye S, Abafogi AA, Merga H, Husen A, Beyene DT. Mapping the evidence on integrated service delivery for non-communicable and infectious disease comorbidity in sub-Saharan Africa: protocol for a scoping review. BMJ Open 2024; 14:e084740. [PMID: 38904125 PMCID: PMC11191815 DOI: 10.1136/bmjopen-2024-084740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION The concurrent occurrence of infectious diseases (IDs) and non-communicable diseases (NCDs) presents complex healthcare challenges in sub-Saharan Africa (SSA), where healthcare systems often grapple with limited resources. While an integrated care approach has been advocated to address these complex challenges, there is a recognised gap in comprehensive evidence regarding the various models of integrated care, their components and the feasibility of their implementation. This scoping review aims to bridge this gap by examining the breadth and nature of evidence on integrated care models for NCDs and IDs within SSA, thereby updating the current evidence base in the domain. METHODS AND ANALYSIS Based on the Joanna Briggs Institute (JBI) framework for scoping reviews, this study will include peer-reviewed and grey literature reporting on integrated care models for NCD-ID comorbidities in SSA. A comprehensive search of published sources in electronic databases (PubMed, Scopus, Embase, the Cochrane Library, Health System Evidence and Research4Life) and grey literature (Google Scholar, EBSCO Open Dissertations and relevant organisational websites) will be conducted to identify sources of information reported in English from 2018 onwards. The review will consider sources of evidence reporting on integrated care model for NCDs such as diabetes; chronic cardiovascular, respiratory and kidney diseases; cancers; epilepsy; and mental illness, and comorbid IDs such as HIV, tuberculosis and malaria. All sources of evidence will be considered irrespective of the study designs or methods used. The review will exclude sources that solely focus on the differentiated or patient-centred care delivery approach, and that focus on other conditions, populations or settings. The reviewers will independently screen the sources for eligibility and extract data using a JBI-adapted data tool on the Parsifal review platform. Data will be analysed using descriptive and thematic analyses and results will be presented in tables, figures, diagrams and a narrative summary. ETHICS AND DISSEMINATION Ethical approval is not required for this review as it will synthesise published data and does not involve human participants. The final report will be submitted for publication in a peer-reviewed journal. The findings will be used to inform future research. STUDY REGISTRATION OSF: https://doi.org/10.17605/OSF.IO/KFVEY.
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Affiliation(s)
| | | | | | | | | | | | - Fira Abamecha
- Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | | | | | | | | | | | - Hailu Merga
- Epidemiology, Jimma University, Jimma, Ethiopia
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Gibson DG, Meghani A, Ssemagabo C, Wosu A, Kibria GMA, Nareeba T, Gyezaho C, Galiwango E, Nanyonga JK, Pariyo GW, Kajungu D, Rutebemberwa E, Hyder AA. The epidemiology of behavioral risk factors for noncommunicable disease and hypertension: A cross-sectional study from Eastern Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002998. [PMID: 38885252 PMCID: PMC11182527 DOI: 10.1371/journal.pgph.0002998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/20/2024] [Indexed: 06/20/2024]
Abstract
In light of the suboptimal noncommunicable disease (NCD) risk factor surveillance efforts, the study's main objectives were to: (i) characterize the epidemiological profile of NCD risk factors; (ii) estimate the prevalence of hypertension; and (iii) identify factors associated with hypertension in a peri-urban and rural Ugandan population. A population-based cross-sectional survey of adults was conducted at the Iganga-Mayuge Health and Demographic Surveillance System site in eastern Uganda. After describing sociodemographic characteristics, the prevalence of NCD risk factors and hypertension was reported. Prevalence ratios for NCD risk factors were calculated using weighted Poisson regression to identify factors associated with hypertension. Among 3220 surveyed respondents (mean age: 35.3 years (standard error: 0.1), 49.4% males), 4.4% were current tobacco users, 7.7% were current drinkers, 98.5% had low fruit and vegetable consumption, 26.9% were overweight, and 9.3% were obese. There was a high prevalence of hypertension and prehypertension, at 17.1% and 48.8%, respectively. Among hypertensive people, most had uncontrolled hypertension, at 97.4%. When we examined associated factors, older age (adjusted prevalence ratio (APR): 3.1, 95% CI: 2.2-4.4, APR: 5.2, 95% CI: 3.7-7.3, APR: 8.9, 95% CI: 6.4-12.5 among 30-44, 45-59, and 60+-year-old people than 18-29-year-olds), alcohol drinking (APR: 1.6, 95% CI: 1.3-2.0, ref: no), always adding salt during eating (APR: 1.6, 95% CI: 1.1-2.2, ref: no), poor physical activity (APR: 1.3, 95% CI: 1.1-1.6, ref: no), overweight (APR: 1.3, 95% CI: 1.1-1.5, ref: normal weight), and obesity (APR: 2.0, 95% CI: 1.6-2.4, ref: normal weight) had higher prevalence of hypertension than their counterparts. The high prevalence of NCD risk factors highlights the immediate need to implement and scale-up population-level strategies to increase awareness about leading NCD risk factors in Uganda. These strategies should be accompanied by concomitant investment in building health systems capacity to manage and control NCDs.
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Affiliation(s)
- Dustin G. Gibson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ankita Meghani
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Charles Ssemagabo
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Adaeze Wosu
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Tryphena Nareeba
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Collins Gyezaho
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Edward Galiwango
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Judith Kaija Nanyonga
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - George W. Pariyo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dan Kajungu
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Adnan Ali Hyder
- Department of Global Health, Office of the Dean, Milken Institute of Public Health, Washington, District of Columbia, United States of America
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Aytenew TM, Kassaw A, Simegn A, Nibret Mihretie G, Asnakew S, Tesfahun Kassie Y, Demis S, Kefale D, Zeleke S, Necho Asferie W. Uncontrolled hypertension among hypertensive patients in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0301547. [PMID: 38870163 PMCID: PMC11175416 DOI: 10.1371/journal.pone.0301547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 03/18/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Hypertension is a major global public health problem. It currently affects more than 1.4 billion people worldwide, projected to increase to 1.6 billion by 2025. Despite numerous primary studies have been conducted to determine the prevalence of uncontrolled hypertension and identify its associated factors among hypertensive patients in Sub-Saharan Africa, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of uncontrolled hypertension and identify its associated factors. METHODS We have searched PubMed, Google Scholar, and Web of Science databases extensively for all relevant studies. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to compute the overall pooled prevalence of uncontrolled hypertension and the effect size of its associated factors. Variations across the included studies were checked using forest plot, funnel plot, I2 statistics, and Egger's test. RESULTS A total of twenty-six primary studies with a sample size of 11,600 participants were included in the final meta-analysis. The pooled prevalence of uncontrolled hypertension was 50.29% (95% CI: 41.88, 58.69; I2 = 98.98%; P<0.001). Age of the patient [AOR = 1.57: 95% CI: 1.004, 2.44], duration of diagnosis [AOR = 2.57: 95% CI: 1.18, 5.57], non-adherence to physical activity [AOR = 2.13: 95% CI: 1.15, 3.95], khat chewing [AOR = 3.83: 95% CI: 1.59, 9.24] and habitual coffee consumption [AOR = 10.79: 95% CI: 1.84, 63.24] were significantly associated with uncontrolled hypertension among hypertensive patients. CONCLUSIONS The pooled prevalence of uncontrolled hypertension was considerably high. Older age, duration of diagnosis, non-adherence to physical activity, khat chewing and habitual coffee consumption were independent predictors of uncontrolled hypertension. Therefore, health professionals and other responsible stakeholders should encourage hypertensive patients to adhere to regular physical activity, and abstain from khat chewing and habitual coffee consumption. Early identification of hypertension and management of comorbidities is crucial, and it should be emphasized to control hypertension easily.
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Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Simegn
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret Mihretie
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun Kassie
- Department of Emergency Medicine and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shegaw Zeleke
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Zanoni F, Neugut YD, Obayemi JE, Liu L, Zhang JY, Ratner LE, Cohen DJ, Mohan S, Gharavi AG, Keating B, Kiryluk K. Genetic versus self-reported African ancestry of the recipient and neighborhood predictors of kidney transplantation outcomes in 2 multiethnic urban cohorts. Am J Transplant 2024; 24:1003-1015. [PMID: 38331047 PMCID: PMC11144562 DOI: 10.1016/j.ajt.2024.01.033] [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: 09/11/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
African American (AA) kidney recipients have a higher risk of allograft rejection and failure compared to non-AAs, but to what extent these outcomes are due to genetic versus environmental effects is currently unknown. Herein, we tested the effects of recipient self-reported race versus genetic proportion of African ancestry (pAFR), and neighborhood socioeconomic status (SES) on kidney allograft outcomes in multiethnic kidney transplant recipients from Columbia University (N = 1083) and the University of Pennsylvania (N = 738). All participants were genotyped with SNP arrays to estimate genetic admixture proportions. US census tract variables were used to analyze the effect of neighborhood factors. In both cohorts, self-reported recipient AA race and pAFR were individually associated with increased risk of rejection and failure after adjustment for known clinical risk factors and neighborhood SES factors. Joint analysis confirmed that self-reported recipient AA race and pAFR were both associated with a higher risk of allograft rejection (AA: HR 1.61 (1.31-1.96), P = 4.05E-06; pAFR: HR 1.90 (1.46-2.48), P = 2.40E-06) and allograft failure (AA: HR 1.52 (1.18-1.97), P = .001; pAFR: HR 1.70 (1.22-2.35), P = .002). Further research is needed to disentangle the role of genetics versus environmental, social, and structural factors contributing to poor transplantation outcomes in kidney recipients of African ancestry.
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Affiliation(s)
- Francesca Zanoni
- Department of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Y Dana Neugut
- Division of Pediatric Gastroenterology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joy E Obayemi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lili Liu
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Jun Y Zhang
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - David J Cohen
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Ali G Gharavi
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Brendan Keating
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA.
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Stroppa C, Hunjan I, Umulisa A, Irebe B, Parati G, Bianchetti MG, Muvunyi B, Ntaganda E, Sinabubaraga V, Radovanovic D, Lava SAG, Muggli F. Single-Pill, Triple Antihypertensive Therapy in Rural Sub-Saharan Africa: Preliminary Experience. Cardiol Ther 2024; 13:431-442. [PMID: 38345713 PMCID: PMC11093960 DOI: 10.1007/s40119-024-00358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/22/2024] [Indexed: 05/15/2024] Open
Abstract
INTRODUCTION Worldwide, arterial hypertension is the foremost preventable and modifiable cardiovascular risk factor. In addition to lifestyle changes, recent international guidelines recommend single-pill, low-dose combinations as initial treatment strategy. We investigated whether this approach is feasible in a rural sub-Saharan Africa setting. METHODS Diagnosis of hypertension was established over three sets of blood pressure measurements, performed according to the European Society of Hypertension recommendations by trained personnel, using a validated, automated, oscillometric device OMRON M7 IT-HEM-7322-E. In 98 individuals with arterial hypertension, a once-daily, single-pill combination of olmesartan, amlodipine, and hydrochlorothiazide was prescribed at an appropriate dose. Patients were instructed on its administration and potential side effects and encouraged towards lifestyle modifications. The treatment regimen was adjusted, if needed, at each outpatient clinic scheduled after 4, 8, 12, and 16 weeks. RESULTS Seventy-nine patients (aged 61 [53-70] years; median and interquartile range) strictly adhered to the treatment schedule, while 19 individuals (70 [65-80] years) dropped out. Blood pressure was < 140/90 mmHg after 4 weeks in 44 (56%), after 8 weeks in 62 (78%), after 12 weeks in 69 (87%), and after 16 weeks in 74 (94%) participants. Excellent tolerance was reported. CONCLUSIONS These results provide real-life evidence that hypertension management with a once-daily, single-pill combination of olmesartan, amlodipine, and hydrochlorothiazide as initial treatment is feasible and effective also in a rural sub-Saharan setting. Single-pill combinations should be made available also in rural and remote areas in low- and middle-income countries as a reliable first-line treatment strategy.
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Affiliation(s)
- Clara Stroppa
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Family Medicine Institute, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Isabella Hunjan
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Family Medicine Institute, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Alice Umulisa
- Health Care Centre of Nyamyumba, Nyamyumba, District of Nyaruguru, Rwanda
| | - Benitha Irebe
- Health Care Centre of Nyamyumba, Nyamyumba, District of Nyaruguru, Rwanda
| | - Gianfranco Parati
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy
| | - Mario G Bianchetti
- Family Medicine Institute, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Bienvenu Muvunyi
- Medical Specialized Services, King Faisal Hospital, Kigali, Rwanda
| | - Evariste Ntaganda
- Cardiovascular Diseases Unit, Non-Communicable Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Dragana Radovanovic
- Family Medicine Institute, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, 1011, Lausanne, Switzerland.
- Clinical Pharmacology & Therapeutics Group, University College London, London, UK.
| | - Franco Muggli
- Family Medicine Institute, Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
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Konkor I, Bisung E, Soliku O, Ayanore M, Kuuire V. Exposure to mass media chronic health campaign messages and the uptake of non-communicable disease screening in Ghana. PLoS One 2024; 19:e0302942. [PMID: 38820497 PMCID: PMC11142513 DOI: 10.1371/journal.pone.0302942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/15/2024] [Indexed: 06/02/2024] Open
Abstract
The main goal of this study was to examine the relationship between exposure to mass media health campaign massages and the uptake of non-communicable diseases (NCDs) screening services in Ghana and whether this relationship differs by place of residence. Available evidence suggests a general low uptake of NCDs screening in developing country settings. Unfortunately, many NCDs evolve very slowly and are consequently difficult to detect early especially in situations where people do not screen regularly and in settings where awareness is low. In this study, we contribute to understanding the potential role of the media in scaling up NCDs screening in developing countries. We fitted multivariate logistic regression models to a sample of 1337 individual surveys which were collected at the neighborhood level in three Ghanaian cities. Overall, the results show that exposure to mass media chronic NCD health campaign messages was significantly associated with increased likelihood of screening for NCDs. The results further highlight neighborhood-level disparities in the uptake of NCDs screening services as residents of low-income and deprived neighborhoods were significantly less likely to report being screened for NCDs. Other factors including social capital, knowledge about the causes of NCDs and self-rated health predicted the likelihood of chronic NCDs screening. The results demonstrate mass media can be an important tool for scaling up NCDs screening services in Ghana and similar contexts where awareness might be low. However, place-based disparities need to be addressed.
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Affiliation(s)
- Irenius Konkor
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, Canada
| | - Elijah Bisung
- School of Kinesiology and Health Studies, Queen’s University Kingston, Kingston, ON, Canada
| | - Ophelia Soliku
- Department of Community Development, SD Dombo University of Business and Integrated Development Studies, Bamahu, Upper West Region, Ghana
| | - Martin Ayanore
- Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Vincent Kuuire
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, Canada
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto–St. George, Toronto, ON, Canada
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Flack KA, Rainey ES, Urasa SJ, Koipapi S, Kalaria RN, Howlett WP, Mukaetova-Ladinska EB, Dekker MCJ, Gray WK, Walker RW, Dotchin CL, Mtwaile H, Lewis TCD, Stone LG, McNally RJQ, Makupa PC, Paddick SM. Lack of Association of Vascular Risk Factors with HIV-Associated Neurocognitive Disorders in cART-Treated Adults Aged ≥ 50 Years in Tanzania. Viruses 2024; 16:819. [PMID: 38932112 PMCID: PMC11209468 DOI: 10.3390/v16060819] [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: 01/08/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity, but data from sub-Saharan Africa are lacking. We evaluated relationships of VRFs, vascular end-organ damage and HAND in individuals aged ≥ 50 in Tanzania. c-ART-treated individuals were assessed for HAND using consensus criteria. The prevalence of VRFs and end organ damage markers were measured. The independent associations of VRFs, end organ damage and HAND were examined using multivariable logistic regression. Data were available for 153 individuals (median age 56, 67.3% female). HAND was highly prevalent (66.7%, 25.5% symptomatic) despite well-managed HIV (70.5% virally suppressed). Vascular risk factors included hypertension (34%), obesity (10.5%), hypercholesterolemia (33.3%), diabetes (5.3%) and current smoking (4.6%). End organ damage prevalence ranged from 1.3% (prior myocardial infarction) to 12.5% (left ventricular hypertrophy). Measured VRFs and end organ damage were not independently associated with HAND. The only significant association was lower diastolic BP (p 0.030, OR 0.969 (0.943-0.997). Our results suggest that vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation.
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Affiliation(s)
- Katherine A. Flack
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Emma S. Rainey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Sarah J. Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Sengua Koipapi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Rajesh N. Kalaria
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - William P. Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Elizabeta B. Mukaetova-Ladinska
- Department of Neuroscience, Behaviour and Psychology, University of Leicester, Leicester LE1 7HA, UK
- The Evington Centre, Leicester General Hospital, Leicester LE5 4QF, UK
| | - Marieke C. J. Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - William K. Gray
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Richard W. Walker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Catherine L. Dotchin
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Himidi Mtwaile
- Department of Radiology, NSK Hospital, Arusha P.O. Box 3114, Tanzania
| | - Thomas C. D. Lewis
- Department of Old Age Psychiatry, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne NE4 6BE, UK
| | - Lydia G. Stone
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | | | - Philip C. Makupa
- HIV Care and Treatment Centre (CTC), Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro P.O Box 3054, Tanzania
| | - Stella-Maria Paddick
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Gateshead NE8 4YL, UK
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Batubo NP, Nwanze NM, Alikor CA, Auma CI, Moore JB, Zulyniak MA. Empowering healthcare professionals in West Africa-A feasibility study and qualitative assessment of a dietary screening tool to identify adults at high risk of hypertension. PLoS One 2024; 19:e0294370. [PMID: 38662712 PMCID: PMC11045096 DOI: 10.1371/journal.pone.0294370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/09/2024] [Indexed: 04/28/2024] Open
Abstract
Dietary risks significantly contribute to hypertension in West Africa. Food frequency questionnaires (FFQs) can provide valuable dietary assessment but require rigorous validation and careful design to facilitate usability. This study assessed the feasibility and interest of a dietary screening tool for identifying adults at high risk of hypertension in Nigeria. Fifty-eight (58) consenting adult patients with hypertension and their caregivers and 35 healthcare professionals from a single-centre Nigerian hospital were recruited to complete a 27-item FFQ at two-time points and three 24-hour recalls for comparison in a mixed method study employing both quantitative questionnaires and qualitative techniques to elicit free form text. Data analyses were conducted using R software version 4.3.1 and NVivo version 14. The trial was registered with ClinicalTrials.gov: NCT05973760. The mean age of patients was 42.6 ± 11.9 years, with an average SBP of 140.3 ± 29.8 mmHg and a BMI of 29.5 ± 7.1 Kg/m2. The adherence rate was 87.9%, and the mean completion time was 7:37 minutes. 96.6% of patients found the FFQ easy to complete, comprehensive, and valuable. A minority reported difficulty (3.4%), discomfort (10.3%), and proposed additional foods (6.9%). Healthcare professionals considered the dietary screening tool very important (82.9%) and expressed a willingness to adopt the tool, with some suggestions for clarification. Patients and healthcare professionals found the screening tool favourable for dietary counselling in hypertension care. The tailored dietary screening tool (FFQ) demonstrated promising feasibility for integration into clinical care as assessed by patients and healthcare professionals. Successful implementation may benefit from proactive time management and addressing training needs. This user-centred approach provided key insights to refine FFQ and set the foundation for ongoing validity testing and evaluation in clinical practice.
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Affiliation(s)
- Nimisoere P. Batubo
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Nnenna M. Nwanze
- Department of Family Medicine, Rivers State University/Rivers State University of Teaching Hospitals, Port Harcourt, Rivers State, Nigeria
| | - Chizindu A. Alikor
- Department of Internal Medicine, Rivers State University/Rivers State University of Teaching Hospitals, Port Harcourt, Rivers State, Nigeria
| | - Carolyn I. Auma
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - J. Bernadette Moore
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Michael A. Zulyniak
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
- Food, Nutrition and Health Program, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Sarfo FS, Asowata OJ, Akpa OM, Akinyemi J, Wahab K, Singh A, Akpalu A, Opare-Addo PA, Okekunle AP, Ogbole G, Fakunle A, Adebayo O, Obiako R, Akisanya C, Komolafe M, Olunuga T, Chukwuonye II, Osaigbovo G, Olowoyo P, Adebayo PB, Jenkins C, Bello A, Laryea R, Ibinaye P, Olalusi O, Adeniyi S, Arulogun O, Ogah O, Adeoye A, Samuel D, Calys-Tagoe B, Tiwari H, Obiageli O, Mensah Y, Appiah L, Akinyemi R, Ovbiagele B, Owolabi M. Stroke occurrence by hypertension treatment status in Ghana and Nigeria: A case-control study. J Neurol Sci 2024; 459:122968. [PMID: 38518449 PMCID: PMC11073807 DOI: 10.1016/j.jns.2024.122968] [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: 01/06/2024] [Revised: 02/07/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Hypertension is preeminent among the vascular risk factors for stroke occurrence. The wide gaps in awareness, detection, treatment, and control rates of hypertension are fueling an epidemic of stroke in sub-Saharan Africa. PURPOSE To quantify the contribution of untreated, treated but uncontrolled, and controlled hypertension to stroke occurrence in Ghana and Nigeria. METHODS The Stroke Investigative Research and Educational Network (SIREN) is a case-control study across 16 study sites in Ghana and Nigeria. Cases were acute stroke (n = 3684) with age- and sex-matched stroke-free controls (n = 3684). We evaluated the associations of untreated hypertension, treated but uncontrolled hypertension, and controlled hypertension at BP of <140/90 mmHg with risk of stroke occurrence. We assessed the adjusted odds ratio and population-attributable risk of hypertension treatment control status associated with stroke occurrence. RESULTS The frequencies of no hypertension, untreated hypertension, treated but uncontrolled hypertension and controlled hypertension among stroke cases were 4.0%, 47.7%, 37.1%, and 9.2% vs 40.7%, 34.9%, 15.9%, and 7.7% respectively among stroke-free controls, p < 0.0001. The aOR and PAR (95% CI) for untreated hypertension were 6.58 (5.15-8.41) and 35.4% (33.4-37.4); treated but uncontrolled hypertension was 9.95 (7.60-13.02) and 35.9% (34.2-37.5); and controlled hypertension 5.37 (3.90-7.41) and 8.5% (7.6-9.5) respectively. Untreated hypertension contributed a PAR of 47.5% to the occurrence of intracerebral hemorrhage vs 29.5% for ischemic stroke. The aOR of untreated hypertension for stroke occurrence was 13.31 (7.64-23.19) for <50 years; 7.14 (4.51-11.31) for 50-64 years; and 3.48 (2.28-5.30) for 65 years or more. CONCLUSION The contribution of untreated hypertension and treated but uncontrolled hypertension to stroke occurrence among indigenous Africans is substantial. Implementing targeted interventions that address gaps in hypertension prevention and treatment, involving the local population, healthcare providers, and policymakers, can potentially substantially reduce the escalating burden of strokes in Africa.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Osahon Jeffery Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria; Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Joshua Akinyemi
- Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | - Adekunle Fakunle
- Department of Public Health, Osun State University, Osogbo, Nigeria
| | | | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Morenkeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | | | - Paul Olowoyo
- Federal Teaching Hospital, Ido-Ekiti Ado-Ekiti, Nigeria
| | | | | | - Abiodun Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ruth Laryea
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Sunday Adeniyi
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | - Dialla Samuel
- Department of Medicine, University of Ibadan, Nigeria
| | | | - Hemant Tiwari
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Yaw Mensah
- Korle Bu Teaching Hospital, Accra, Ghana
| | - Lambert Appiah
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rufus Akinyemi
- Department of Medicine, University of Ibadan, Nigeria; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| | - Mayowa Owolabi
- Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria; Lebanese American University, Beirut, Lebanon.
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12
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Harikrishnan S, Rath PC, Bang V, McDonagh T, Ogola E, Silva H, Rajbanshi BG, Pathirana A, Ng GA, Biga C, Lüscher TF, Daggubati R, Adivi S, Roy D, Banerjee PS, Das MK. Heart failure, the global pandemic: A call to action consensus statement from the global presidential conclave at the platinum jubilee conference of cardiological society of India 2023. Indian Heart J 2024:S0019-4832(24)00057-9. [PMID: 38609052 DOI: 10.1016/j.ihj.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Heart failure (HF) is emerging as a major public health problem both in high- and low - income countries. The mortality and morbidity due to HF is substantially higher in low-middle income countries (LMICs). Accessibility, availability and affordability issues affect the guideline directed therapy implementation in HF care in those countries. This call to action urges all those concerned to initiate preventive strategies as early as possible, so that we can reduce HF-related morbidity and mortality. The most important step is to have better prevention and treatment strategies for diseases such as hypertension, ischemic heart disease (IHD), type-2 diabetes, and rheumatic heart disease (RHD) which predispose to the development of HF. Setting up dedicated HF-clinics manned by HF Nurses, can help in streamlining HF care. Subsidized in-patient care, financial assistance for device therapy, use of generic medicines (including polypill strategy) will be helpful, along with the use of digital technologies.
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Affiliation(s)
| | - Prathap Chandra Rath
- Apollo Health City, Jubilee Hills, Hyderabad, President, Cardiological Society of India (CSI), India
| | - Vijay Bang
- Lilavati Hospital, Bandra West, Mumbai, Immediate Past-President, CSI, India
| | | | - Elijah Ogola
- University of Nairobi (Kenya), President Pan African Society of Cardiology, Kenya
| | - Hugo Silva
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Treasurer, Argentinian Cardiac Society, Argentina
| | - Bijoy G Rajbanshi
- Nepal Mediciti, Lalitpur, Past-President, Cardiac Society of Nepal, Nepal
| | - Anidu Pathirana
- National Hospital of SriLanka, Past-President SriLanka Heart Association, Sri Lanka
| | - G Andre Ng
- University of Leicester, President-Elect, British Cardiovascular Society, United Kingdom
| | - Cathleen Biga
- President and CEO of Cardiovascular Management of Illinois, Vice President, American College of Cardiology, USA
| | - Thomas F Lüscher
- Royal Brompton Hospital Imperial College London, London, President-Elect European Society of Cardiology, United Kingdom
| | - Ramesh Daggubati
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Shirley Adivi
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Debabrata Roy
- Rabindranath Tagore Institute of Cardiac Sciences, Kolkata, Hon. General Secretary, CSI, India
| | - P S Banerjee
- Manipal Hospital, Kolkata, Past-President, CSI, India
| | - M K Das
- B.M. Birla Heart Research Centre, Kolkata, Past-President CSI, India
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13
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Grisel B, Adisa O, Sakita FM, Tarimo TG, Kweka GL, Mlangi JJ, Maro AV, Yamamoto M, Coaxum L, Arthur D, Limkakeng AT, Hertz JT. Evaluating the performance of the HEART score in a Tanzanian emergency department. Acad Emerg Med 2024; 31:361-370. [PMID: 38400615 PMCID: PMC11060095 DOI: 10.1111/acem.14872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE The HEART score successfully risk stratifies emergency department (ED) patients with chest pain in high-income settings. However, this tool has not been validated in low-income countries. METHODS This is a secondary analysis of a prospective observational study that was conducted in a Tanzanian ED from January 2019 through January 2023. Adult patients with chest pain were consecutively enrolled, and their presenting symptoms and medical history were recorded. Electrocardiograms and point-of-care troponin assays were obtained for all participants. Thirty-day follow-up was conducted, assessing for major adverse cardiac events (MACEs), defined as death, myocardial infarction, or coronary revascularization (coronary artery bypass grafting or percutaneous coronary intervention). HEART scores were calculated for all participants. Likelihood ratios, sensitivity, specificity, and negative predictive values (NPVs) were calculated for each HEART cutoff score to predict 30-day MACEs, and area under the curve (AUC) was calculated from the receiver operating characteristic curve. RESULTS Of 927 participants with chest pain, the median (IQR) age was 61 (45.5-74.0) years. Of participants, 216 (23.3%) patients experienced 30-day MACEs, including 163 (17.6%) who died, 48 (5.2%) with myocardial infarction, and 23 (2.5%) with coronary revascularization. The positive likelihood ratio for each cutoff score ranged from 1.023 (95% CI 1.004-1.042; cutoff ≥ 1) to 3.556 (95% CI 1.929-6.555; cutoff ≥ 7). The recommended cutoff of ≥4 to identify patients at high risk of MACEs yielded a sensitivity of 59.4%, specificity of 52.8%, and NPV of 74.7%. The AUC was 0.61. CONCLUSIONS Among patients with chest pain in a Tanzanian ED, the HEART score did not perform as well as in high-income settings. Locally validated risk stratification tools are needed for ED patients with chest pain in low-income countries.
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Affiliation(s)
- Braylee Grisel
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Olanrewaju Adisa
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Francis M Sakita
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tumsifu G Tarimo
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Godfrey L Kweka
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jerome J Mlangi
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Amedeus V Maro
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Marilyn Yamamoto
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren Coaxum
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - David Arthur
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Alexander T Limkakeng
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Julian T Hertz
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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14
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Mekonen HH, Gebru TH, Kiros KG, Gebrehiwot TG, Tesfamichael YA. Undiagnosed hypertension and associated factors among adult population in central zone of Tigray, Northern Ethiopia 2020: A cross-sectional study. Health Sci Rep 2024; 7:e2052. [PMID: 38655424 PMCID: PMC11035904 DOI: 10.1002/hsr2.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims Undiagnosed hypertension is a major risk factor for cardiovascular diseases and complications such as heart attack and stroke. Limited information is available on the prevalence of undiagnosed hypertension and its associated factors in Ethiopia, particularly in the study setting. This study aimed to assess the prevalence of undiagnosed hypertension and its associated factors in the central zone of Tigray, Northern Ethiopia. Methods A community-based cross-sectional study was conducted from April 1 to May 31, 2020. A pretested structured questionnaire was used and both face-to-face interview and physical measurement were used to collect the data. Blood pressure was measured on two different days for each study participant, and an average of the measurements were taken. In addition, 736 participants were included in this study, through a systematic random sampling technique. Data were analyzed using SPSS version 23. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with undiagnosed hypertension. Adjusted odds ratios and 95% confidence intervals were used to show the strength of the association and declare statistical significance at p < 0.05. Results In the study, the mean age of the participants was 51.9 (standard deviation: 17.9) years old. Prevalence of undiagnosed hypertension was found 15.4% (N = 113). The factors associated with undiagnosed hypertension were being divorced (adjusted odds ratio [AOR] = 15.2, 95% confidence interval [CI]: 8.2-28.3), alcohol consumption (AOR = 2.07, 95% CI: 1.22-3.51), not eating fruits (AOR = 4.1, 95% CI: 2.37-7.08), not eating vegetables (AOR = 3.47, 95% CI: 2.02-5.96) and poor knowledge (AOR = 3.05, 95% CI: 2.75-7.83). Conclusion Around one in six study participants had undiagnosed hypertension. Being divorced, drinking alcohol, not eating fruits, not consuming vegetables, and having poor knowledge of hypertension were significant factors. Public health interventions, like providing adequate hypertension health information, frequent screening, and implementation of an appropriate intervention for particular factors, are critical for reducing the burden of undiagnosed hypertension.
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Affiliation(s)
- Haftea Hagos Mekonen
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
| | - Tsegu Hailu Gebru
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
| | - Kbrom Gemechu Kiros
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
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15
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Adeke AS, Chori BS, Neupane D, Sharman JE, Odili AN. Socio-demographic and lifestyle factors associated with hypertension in Nigeria: results from a country-wide survey. J Hum Hypertens 2024; 38:365-370. [PMID: 35332218 PMCID: PMC11001570 DOI: 10.1038/s41371-022-00673-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 11/09/2022]
Abstract
With the rising prevalence of hypertension, especially in Africa, understanding the dynamics of socio-demographic and lifestyle factors is key in managing hypertension. To address existing gaps in evidence of these factors, this study was carried out. A cross-sectional survey using a modified WHO STEPS questionnaire was conducted among 3782 adult Nigerians selected from an urban and a rural community in one state in each of the six Nigerian regions. Among participants, 56.3% were women, 65.8% were married, 52.5% resided in rural areas, and 33.9% had tertiary education. Mean ages (SD) were 53.1 ± 13.6 years and 39.2 ± 15.0 years among hypertensive persons and their normotensive counterparts respectively. On lifestyle, 30.7% had low physical activity, 4.1% consumed tobacco currently, and 35.4% consumed alcohol currently. In comparison to unmarried status, being married (OR = 1.88, 95% CI: 1.41-2.50) or widowed (OR = 1.57, 95% CI: 1.05-2.36) was significantly associated with hypertension, compared with never married. Compared with no formal education, primary (OR = 1.44, 95% CI: 1.12-1.85), secondary (OR = 1.37, 95% CI: 1.04-1.81), and tertiary education (OR = 2.02, 95% CI: 1.57-2.60) were associated with hypertension. Low physical activity (OR = 1.23, 95% CI: 1.05-1.42), alcohol consumption, (OR = 1.18, 95% CI: 1.02-1.37), and unemployment status (OR = 1.42; 95% CI: 1.07-1.88) were also associated with hypertension. Our study indicates an association of socio-demographic and lifestyle factors with hypertension, hence, there is a need for counselling, health education and policy formulation and implementation targeting these factors to prevent and control hypertension.
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Affiliation(s)
- Azuka S Adeke
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Babangida S Chori
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Dinesh Neupane
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Augustine N Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
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16
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Sani RN, Connelly PJ, Toft M, Rowa-Dewar N, Delles C, Gasevic D, Karaye KM. Rural-urban difference in the prevalence of hypertension in West Africa: a systematic review and meta-analysis. J Hum Hypertens 2024; 38:352-364. [PMID: 35430612 PMCID: PMC11001577 DOI: 10.1038/s41371-022-00688-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/16/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022]
Abstract
Urbanisation is considered a major contributor to the rising prevalence of hypertension in West Africa, yet the evidence regarding rural-urban differences in the prevalence of hypertension in the region has been mixed. A systematic literature search of four electronic databases: PubMed, Embase, African Journals Online, and WHO's African Index Medicus; and reference lists of eligible studies was carried out. Original quantitative studies describing the rural-urban difference in the prevalence of hypertension in one or more countries in West Africa, and published in English language from the year 2000 to 2021 were included. A random effects meta-analysis model was used to estimate the odds ratio of hypertension in rural compared to urban locations. A limited sex-based random effects meta-analysis was conducted with 16 studies that provided sex-disaggregated data. Of the 377 studies screened, 22 met the inclusion criteria (n = 62,907). The prevalence of hypertension was high in both rural, and urban areas, ranging from 9.7% to 60% in the rural areas with a pooled prevalence of 27.4%; and 15.5% to 59.2% in the urban areas with a pooled prevalence of 33.9%. The odd of hypertension were lower in rural compared to urban dwellers [OR 0.74, 95% CI: 0.66-0.83; p < 0.001]. The pooled prevalence of hypertension was 32.6% in males, and 30.0% in females, with no significant difference in the odds of hypertension between the sexes [OR 0.91, 95% CI: 0.8-1.05, p = 0.196]. Comprehensive hypertension control policies are needed for both rural, and urban areas in West Africa, and for both sexes.
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Affiliation(s)
- Ruqayya Nasir Sani
- Department of Medicine, Aminu kano Teaching Hospital, Kano, Nigeria.
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK.
| | - Paul J Connelly
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mette Toft
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Neneh Rowa-Dewar
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Christian Delles
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Danijela Gasevic
- Center for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kamilu Musa Karaye
- Department of Medicine, Aminu kano Teaching Hospital, Kano, Nigeria
- Bayero University Kano, Kano, Nigeria
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17
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GNAZÉGBO A, KARIDIOULA HA, SYLLA A, BONY KÉ, KOFFI YT, TOURÉ A, KONÉ BAK, KOUAMÉASSOUAN AÉ. [Evaluation of the management of hypertension among stroke patients in a neurology department of Côte d'Ivoire]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2024; 4:mtsi.v4i1.2024.366. [PMID: 38846129 PMCID: PMC11151912 DOI: 10.48327/mtsi.v4i1.2024.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/12/2023] [Indexed: 06/09/2024]
Abstract
Introduction Reducing blood pressure after stroke is important to prevent recurrent stroke, but we have no data about the control of blood pressure in our context. The purpose of this study was to assess management of hypertension among post-stroke patients in a neurology department. Method It was a retrospective study involving hypertensive stroke patients. They were followed up at 1, 3, 6 and 12 months after discharge. Results 141 patients fulfilled the inclusion criteria. The mean age was 61 years. Almost all patients (94.3%) received a dual antihypertensive therapy combining mainly an ACE inhibitor and a diuretic (70.2%). During follow-up, only 76 patients were assessed at M1, 50 at M3, 44 at M6 and 42 at M12. The average monthly cost of antihypertensive treatment was 13,771 CFA francs (21 euros). Non-adherence to antihypertensive medication were mostly noted in widows, patients without occupation, those with low education and no health insurance. At one year, blood pressure was controlled in 80% of the 42 patients still present. Non-control of blood pressure was related to poor therapeutic compliance (p<0.05). Conclusion This study highlights follow-up issues in hypertensive post-stroke patients with a high number of lost to follow-up. Blood pressure was controlled in patients who were regularly followed and adherent to antihypertensive treatment.
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Affiliation(s)
- Any GNAZÉGBO
- Service de neurologie, Centre hospitalier universitaire de Bouaké, Côte d'Ivoire
| | | | - Assata SYLLA
- Service de neurologie, Centre hospitalier universitaire de Bouaké, Côte d'Ivoire
| | - Kotchi Élysée BONY
- Service de neurologie, Centre hospitalier universitaire de Bouaké, Côte d'Ivoire
| | | | - Aïcha TOURÉ
- Service de neurologie, Centre hospitalier universitaire de Bouaké, Côte d'Ivoire
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Hazim CE, Dobe I, Pope S, Ásbjörnsdóttir KH, Augusto O, Bruno FP, Chicumbe S, Lumbandali N, Mate I, Ofumhan E, Patel S, Rafik R, Sherr K, Tonwe V, Uetela O, Watkins D, Gimbel S, Mocumbi AO. Scaling-up and scaling-out the Systems Analysis and Improvement Approach to optimize the hypertension diagnosis and care cascade for HIV infected individuals (SCALE SAIA-HTN): a stepped-wedge cluster randomized trial. Implement Sci Commun 2024; 5:27. [PMID: 38509605 PMCID: PMC10953165 DOI: 10.1186/s43058-024-00564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Undiagnosed and untreated hypertension is a main driver of cardiovascular disease and disproportionately affects persons living with HIV (PLHIV) in low- and middle-income countries. Across sub-Saharan Africa, guideline application to screen and manage hypertension among PLHIV is inconsistent due to poor service readiness, low health worker motivation, and limited integration of hypertension screening and management within HIV care services. In Mozambique, where the adult HIV prevalence is over 13%, an estimated 39% of adults have hypertension. As the only scaled chronic care service in the county, the HIV treatment platform presents an opportunity to standardize and scale hypertension care services. Low-cost, multi-component systems-level strategies such as the Systems Analysis and Improvement Approach (SAIA) have been found effective at integrating hypertension and HIV services to improve the effectiveness of hypertension care delivery for PLHIV, reduce drop-offs in care, and improve service quality. To build off lessons learned from a recently completed cluster randomized trial (SAIA-HTN) and establish a robust evidence base on the effectiveness of SAIA at scale, we evaluated a scaled-delivery model of SAIA (SCALE SAIA-HTN) using existing district health management structures to facilitate SAIA across six districts of Maputo Province, Mozambique. METHODS This study employs a stepped-wedge design with randomization at the district level. The SAIA strategy will be "scaled up" with delivery by district health supervisors (rather than research staff) and will be "scaled out" via expansion to Southern Mozambique, to 18 facilities across six districts in Maputo Province. SCALE SAIA-HTN will be introduced over three, 9-month waves of intensive intervention, where technical support will be provided to facilities and district managers by study team members from the Mozambican National Institute of Health. Our evaluation of SCALE SAIA-HTN will be guided by the RE-AIM framework and will seek to estimate the budget impact from the payer's perspective. DISCUSSION SAIA packages user-friendly systems engineering tools to support decision-making by frontline health workers and to identify low-cost, contextually relevant improvement strategies. By integrating SAIA delivery into routine management structures, this pragmatic trial will determine an effective strategy for national scale-up and inform program planning. TRIAL REGISTRATION ClinicalTrials.gov NCT05002322 (registered 02/15/2023).
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Affiliation(s)
- Carmen E Hazim
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA.
| | - Igor Dobe
- Instituto Nacional de Saúde, Vila de Marracuene, Província de Maputo, Mozambique
| | - Stephen Pope
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kristjana H Ásbjörnsdóttir
- Centre of Public Health Sciences, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, WA, USA
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Fernando Pereira Bruno
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Washington D.C, USA
| | - Sergio Chicumbe
- Instituto Nacional de Saúde, Vila de Marracuene, Província de Maputo, Mozambique
| | - Norberto Lumbandali
- Instituto Nacional de Saúde, Vila de Marracuene, Província de Maputo, Mozambique
| | - Inocêncio Mate
- Instituto Nacional de Saúde, Vila de Marracuene, Província de Maputo, Mozambique
| | - Elso Ofumhan
- Mozambique Institute for Health Education and Research, Maputo, Mozambique
| | - Sam Patel
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Riaze Rafik
- Mozambique Institute for Health Education and Research, Maputo, Mozambique
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Veronica Tonwe
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Washington D.C, USA
| | - Onei Uetela
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - David Watkins
- Department of Global Health, University of Washington, Seattle, WA, USA
- Division of General Internal Medicine, Harborview Medical Center, Seattle, WA, USA
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Ana O Mocumbi
- Instituto Nacional de Saúde, Vila de Marracuene, Província de Maputo, Mozambique
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
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Badacho AS, Mahomed OH. Lived experiences of people living with HIV and hypertension or diabetes access to care in Ethiopia: a phenomenological study. BMJ Open 2024; 14:e078036. [PMID: 38417958 PMCID: PMC10900422 DOI: 10.1136/bmjopen-2023-078036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND People living with HIV (PLWH) are more likely to develop hypertension and diabetes than people without HIV. Previous studies have shown that HIV stigma, discrimination and exclusion make it difficult for PLWH to access care for hypertension and diabetes. OBJECTIVES This study aimed to explore the lived experiences of PLWH with comorbid hypertension or diabetes to access hypertension and diabetes care in southern Ethiopia. DESIGN We conducted a qualitative study using a semistructured interview guide for an in-depth, in-person interview. SETTINGS From 5 August to 25 September 2022, PLWH with comorbid hypertension or diabetes were purposefully selected from five primary healthcare (PHC) facilities in the Wolaita zone of southern Ethiopia. PARTICIPANTS A total of 14 PLWH with comorbid hypertension or diabetes who were receiving antiretroviral therapy from PHC were interviewed. Among them, 10 were women, and 4 were men. METHODS In-person, in-depth interviews were conducted. Qualitative data analysis software (NVivo V.12) was used to assist with the data organisation, and Colaizzi's (1978) inductive thematic analyses were conducted to explore key concepts. RESULT This study yielded two main themes: Theme 1: barriers to accessing care as individual barriers to access (low awareness of non-communicable diseases, misperceptions, lack of health insurance and cost of treatment); healthcare system barriers (shortage of supplies, drugs and equipment; long wait times; lack of integrated services; absence of routine screening and lack of respect from providers); community barriers (lack of support from families, friends and the community) and stigma and discrimination access to hypertension and diabetes. Theme 2: accessibility facilitators (support from family, friends and organisations; health insurance coverage). CONCLUSION PLWH recommended that access to services can be improved by service integration, awareness-raising activities, no user fee charges for hypertension and diabetes care and routine screening.
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Affiliation(s)
- Abebe Sorsa Badacho
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Ozayr Haroon Mahomed
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Dasman Diabetes Institute, Kuwait City, Kuwait
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20
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Eslami H, Halimi Milani F, Salehnia F, Kourehpaz N, Katebi K. Relationship between sublingual varices and hypertension: a systematic review and meta-analysis. BMC Oral Health 2024; 24:240. [PMID: 38360643 PMCID: PMC10868067 DOI: 10.1186/s12903-024-03982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Previous research has investigated the connection between sublingual varices (SV) and cardiovascular disease, aging, and smoking. However, it is still unclear whether arterial hypertension affects the presence of SV. This meta-analysis aimed to investigate the relationship between hypertension and the presence of SV. METHODS The literature search was performed using PubMed, Web of Science, Scopus, Google Scholar, and Embase for cross-sectional studies until July 2023. PRISMA guidelines were used for article selection. A meta-analysis using standardized mean differences by a random effects model was conducted to pool studies. RESULTS A total of 568 articles were retrieved, of which twelve were included in the meta-analysis. Cumulatively, 2543 samples in the case group (1185 with hypertension) and 3897 samples (821 with hypertension) were studied in the control group. Using the random effects model, the pooled odds ratio (OR) revealed a significant association between hypertension and sublingual varices (OR = 2.66; 95% CI: 1.69-4.18). CONCLUSION The meta-analysis showed a significant and positive association between sublingual varices and hypertension. SV's presence could be used by dentists as a non-invasive indicator of hypertension screening.
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Affiliation(s)
- Hosein Eslami
- Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Salehnia
- Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negar Kourehpaz
- Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Katayoun Katebi
- Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
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21
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Sadiq E, von Klemperer A, Woodiwiss A, Norton G, Modi G. Stroke as the index presentation of traditional cardiovascular risk factors and Human Immunodeficiency Virus in a South African population. J Stroke Cerebrovasc Dis 2024; 33:107529. [PMID: 38103446 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES We sought to identify what proportion of each cardiovascular risk factor and Human Immunodeficiency Virus (HIV) was first diagnosed at the time of stroke, compared to those that were diagnosed prior to the event, and to explore if this had any impact on the severity of stroke. METHODS Adult patients presenting with a new stroke to a quaternary hospital in Johannesburg between 2014 and 2017 were prospectively recruited. Patients were investigated for undiagnosed traditional cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidaemia, atrial fibrillation, obesity and smoking), as well as HIV infection. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). RESULTS 346 patients were included. Stroke was the index presentation for at least one risk factor in 199 (57.5 %) patients. Dyslipidaemia was newly diagnosed in 76.0 % of all dyslipidaemics (95 out of 125). Newly-diagnosed dyslipidaemia was associated with a more severe neurological deficit (Median NIHSS of 12 (8-16) vs 7 (4-12), p=0.0007) and younger age on presentation (53 (44-63) years vs 62 (51-71) years, p=0.02) as compared to previously-diagnosed dyslipidaemia. CONCLUSIONS More than half of patients had previously undiagnosed modifiable risk factors at the time of their stroke. Dyslipidaemia was undiagnosed in a very high proportion, and this was associated with a higher stroke severity and younger age of presentation.
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Affiliation(s)
- Eitzaz Sadiq
- Division of Neurology, Department of Neurosciences, School of Clinical Medicine and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa.
| | - Alexander von Klemperer
- Division of Neurology, Department of Neurosciences, School of Clinical Medicine and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
| | - Angela Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Girish Modi
- Division of Neurology, Department of Neurosciences, School of Clinical Medicine and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
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22
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Molefe-Baikai OJ, Kebotsamang K, Modisawakgomo P, Tlhakanelo JT, Motlhatlhedi K, Moshomo T, Youssouf NF, Masupe T, Gaolathe T, Tapela N, Lockman S, Mosepele M. Self-reported cardiovascular disease risk factor screening among people living with HIV vs. members of the general population in Botswana: a community-based study. BMC Public Health 2024; 24:198. [PMID: 38229024 PMCID: PMC10792864 DOI: 10.1186/s12889-024-17651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Morbidity and mortality due to cardiovascular diseases (CVDs) are high and increasing in low- and middle-income countries. People living with HIV (PLWH) are more likely to experience CVD than members of the general population. Therefore, we aimed to assess whether PLWH were more likely to have previously been screened for cardiovascular disease risk factors (CVDRFs) than people without HIV. METHODS A population-based, cross-sectional study was conducted among individuals aged 16 to 68 years across 22 communities in Botswana from February to August 2017 as part of a larger community-based cluster randomized HIV treatment-as-prevention trial. Participants were asked if they had been screened for and counselled on cardiovascular disease risk factors (history of hypertension or blood pressure check, blood glucose and cholesterol measurements, weight check and weight control, tobacco smoking and cessation, alcohol use and physical activity) in the preceding 3 years. HIV testing was offered to those with an unknown HIV status. Multiple logistic regression analysis controlling for age and sex was used to assess the relationship between CVDRF screening and HIV status. RESULTS Of the 3981 participants enrolled, 2547 (64%) were female, and 1196 (30%) were PLWH (93% already on antiretroviral therapy [ART]). PLWH were more likely to report previous screening for diabetes (25% vs. 19%, p < 0.001), elevated cholesterol (17% vs. 12%, p < 0.001) and to have had their weight checked (76% vs. 55%, p < 0.001) than HIV-uninfected participants. PLWH were also more likely to have received counselling on salt intake (42% vs. 33%, p < 0.001), smoking cessation (66% vs. 46%, p < 0.001), weight control (38% vs. 29%, p < 0.001), physical activity (46% vs. 34%, p < 0.001) and alcohol consumption (35% vs. 23%, p < 0.001) than their HIV-uninfected counterparts. Overall, PLWH were more likely to have received screening for and/or counselling on CVDRFs (adjusted odds ratio 1.84, 95% CI: 1.46-2.32, p < 0.001). CONCLUSION PLWH were almost two times more likely to have been previously screened for CVDRFs than those without HIV, indicating a need for universal scale-up of integrated management and prevention of CVDs in the HIV-uninfected population.
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Affiliation(s)
- Onkabetse Julia Molefe-Baikai
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana.
| | - Kago Kebotsamang
- Faculty of Social Sciences, Department of Statistics, University of Botswana, Gaborone, Botswana
| | | | - John Thato Tlhakanelo
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Keneilwe Motlhatlhedi
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Thato Moshomo
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
| | - Nabila Farah Youssouf
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- London School of Hygiene and Tropical Medicine, London, UK
| | - Tiny Masupe
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Tendani Gaolathe
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- International Consortium for Health Outcomes Measurement, Boston, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA
| | - Mosepele Mosepele
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
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Alinaitwe B, Amanya C, A Muwanguzi P, Ngabirano TD. Prevalence of Risk Factors for Hypertension Among Faculty at an Urban University in Uganda. Integr Blood Press Control 2024; 17:1-11. [PMID: 38196839 PMCID: PMC10773241 DOI: 10.2147/ibpc.s440972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/23/2023] [Indexed: 01/11/2024] Open
Abstract
Purpose Hypertension is a major contributor to morbidity and mortality worldwide. Many people however are not aware of their possession of risk factors for hypertension. There is a paucity of literature in Uganda describing the risk profile of faculty at public universities. The purpose of this study was to determine the prevalence of hypertension risk factors among university teaching staff. Methods This study was conducted among faculty at Makerere University in Uganda. The modified World Health Organization STEP-wise approach for non-communicable disease surveillance was used in data collection. Hypertension was defined as having a systolic blood pressure of ≥140mmHg and/or a diastolic blood pressure of ≥90mmHg, or being on antihypertensive medications. Participants were enrolled from the faculty lists by proportionate to size systematic sampling until the sample size for each college was obtained. Data was collected from January to March 2018. Multivariate logistic regression was used to determine factors associated with hypertension. Results A total of 141 participants were recruited into the study. The prevalent risk factors for hypertension include physical inactivity (78.7%), overweight (46.8%), obesity (20.6%), addition of extra salt to food (46.8%), current alcohol consumption (33.3%), history of smoking (10.6%), inadequate fruit and vegetable servings per day (100%), family history of hypertension (40.4%) and a family history of diabetes (22.7%). Hypertension was prevalent at 26.2% (95% CI 18.94-33.46%). The risk factors significantly associated with hypertension included a family history of hypertension (p=0.009), obesity (p=0.008) and male gender (p = 0.029). Conclusion The prevalence of known hypertension risk factors among university teaching staff in urban Uganda is high. Majority of these risk factors are modifiable highlighting the need for continuous screening as well as introduction of prevention and health promotion strategies to reduce the risk burden.
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Affiliation(s)
- Businge Alinaitwe
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Nursing, Mount Kenya University, Thika, Kenya
| | - Charles Amanya
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Research, Hoima Regional Referral Hospital, Hoima, Uganda
| | - Patience A Muwanguzi
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tom Denis Ngabirano
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
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24
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Povia JP, Masenga SK, Hamooya BM, Gebremeskel Y. Productivity-adjusted life-years and correlates of uncontrolled hypertension at two health facilities in Zambia. PLoS One 2023; 18:e0295401. [PMID: 38060497 PMCID: PMC10703239 DOI: 10.1371/journal.pone.0295401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Hypertension has in the recent past surfaced as one of the conditions that has a significant impact on workforce productivity in emerging economies. Zambia is no different and has in the recent past recorded increasing cases. Despite the impact of hypertension being of great importance in regards to productivity, we have scarcity of data and studies on hypertension-related Productivity-Adjusted Life-Years (PALYs) in Zambia and Africa at large. This study assessed the impact of hypertension on PALYs lost and socioeconomic factors associated with nonadherence to antihypertensive medication (NATAM). METHODS This was a cross-sectional study of 198 participants from Livingstone University Teaching Hospital and Maramba Clinic situated in Livingstone, Zambia. Structured questionnaires were used to collect data. Productivity index multiplied by years lived was used to calculate PALYs and descriptive statistics were used to summarize sociodemographic, clinical and economic variables. Multivariable logistic regression was used to determine factors associated with NATAM. RESULTS The participants had a median age (interquartile range (IQR)) of 49 years (41, 59) and 60.1% (n = 119) were females while 39.9% (n = 79) were male. Our estimated PALYs lost per person due to hypertension were 0.2 (IQR 0.0, 2.7). Cumulative PALYs value lost due to the burden of hypertension was estimated to be at $871,239.58 in gross domestic product (GDP). The prevalence of NATAM was 48% (n = 95). The factors that were significantly associated with NATAM were age (odds ratio (OR) 0.94; 95% confidence interval (CI) 0.90, 0.98), female sex (OR 2.52; 95%CI 1.18, 5.40), self-employment (OR 2.57; 95%CI 1.02, 6.45) and absenteeism from work (OR 3.60; 95%CI 1.16, 11.22). CONCLUSIONS Findings in our study highlight a high economic loss of PALYs due to hypertension with a potential to impact GDP negatively. We also found that NATAM reduced productivity and income among individuals of working age further impacting PALYs lost due to hypertension. The factors associated with NATAM were age, sex, employment status and absenteeism from work. This study underscores the need for interventions targeting young people, females, self-employed individuals, and absentees at work to improve adherence to antihypertensive drugs in order to reduce PALYs lost due to hypertension.
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Affiliation(s)
- Joreen P. Povia
- Department of Economics, School of Social Sciences, Mulungushi University, Kabwe, Zambia
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Sepiso K. Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Benson M. Hamooya
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Yordanos Gebremeskel
- Department of Economics, School of Social Sciences, Mulungushi University, Kabwe, Zambia
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Fotouhi F, Shahidi A, Hashemi H, Saffarpour M, Yekta A, Esmaieli R, Esteki T, Derakhshan HB, Khabazkhoob M. Hypertension prevalence in Iran's elderly according to new criteria: the Tehran Geriatric Eye Study. J Diabetes Metab Disord 2023; 22:1489-1498. [PMID: 37975137 PMCID: PMC10638178 DOI: 10.1007/s40200-023-01272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/27/2023] [Indexed: 11/19/2023]
Abstract
Purpose To determine the prevalence of hypertension in a population above 60 years of age and its relationship with demographic and anthropometric factors. Methods A cross-sectional population-based study was conducted in 2019. Using a multistage random cluster sampling, 160 clusters were selected from 22 districts of Tehran. All participants were interviewed to collect demographic, anthropometric, and socioeconomic information. Then, systolic (SBP) and diastolic (DBP) blood pressures were measured under standard conditions twice, 10 min apart. A third measurement was performed if the two measurements showed a difference of ≥ 10 mmHg in SBP or ≥ 5 mmHg in DBP. Hypertension was defined as a SBP > 130 mmHg or a DBP > 80 mmHg (new criteria), being a known case of hypertension, or use of blood pressure lowering medications. Results Of 3791 invitees, 3310 participated in the study (87.3%). The mean age of the participants was 68.25 ± 6.54 years (60-97 years). The prevalence of hypertension was 81.08% (95% CI: 79.57-82.59) in the whole sample; 82.96% (95% CI: 81.02-84.91) in females, and 79.15% (95% CI: 76.6 -81.69) in males. The prevalence of hypertension ranged from 75.47% (95% CI: 72.65-78.29) in the age group 60-64 years to 88.40% (95% CI: 83.71-93.08) in the age group ≥ 80 years. The prevalence of hypertension unawareness was 32.84% (95% CI: 30.82-34.86). The highest and lowest prevalence of hypertension was seen in illiterate subjects (89.41%) and those with a university education (77.14%), respectively. According to the multiple logistic regression analysis, older age, lower education level, obesity and overweight, neck circumference, and diabetes were significantly associated with the prevalence of hypertension. Conclusion A significant percentage of Iranian elderly have hypertension and one of every 3 affected individuals is unaware of their disease. Considering the population aging in Iran, urgent and special attention should be paid to the elderly population. Caring for the elderly, informing families, and using non-traditional screening methods are recommended by families at the first level and policymakers at the macro level.
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Affiliation(s)
- Farid Fotouhi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Shahidi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mahshid Saffarpour
- Department of Restorative Dentistry, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roghayeh Esmaieli
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Taraneh Esteki
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoon Bana Derakhshan
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Suliman A, Tadesse S, Abute L, Selamu M. Prevalence of undiagnosed hypertension and associated factors among adults in Durame town, Southern Ethiopia: a cross-sectional study. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1205857. [PMID: 38455904 PMCID: PMC10910906 DOI: 10.3389/fepid.2023.1205857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/16/2023] [Indexed: 03/09/2024]
Abstract
Background Undiagnosed hypertension is a major public health problem causing severe cardiovascular disorders that are responsible for a high proportion of morbidities and mortalities, especially among adults living in low-income countries. However, there is a paucity of information that describes its epidemiology in Ethiopia. This study aimed to assess the prevalence of undiagnosed hypertension and associated factors among adults in Durame town, southern Ethiopia. Methods A community-based cross-sectional study was conducted from July to September 2022. Data were collected from 526 randomly selected adults aged ≥18 years using a pre-tested questionnaire. The binary logistic regression models were used to identify factors associated with undiagnosed hypertension. Results The prevalence of undiagnosed hypertension among adults in Durame town, southern Ethiopia, was found to be 14.0% (95% CI: 11.2-17.1). Family history of hypertension [AOR = 6.9, 95% CI: (3.62, 13.27)], drinking too much alcohol [AOR = 5.7, 95% CI: (2.97, 10.75)], physical inactivity [AOR = 2.5, 95% CI: (1.34, 4.73)], consuming street foods regularly [AOR = 2.8, 95% CI: (1.28, 6.01)], and seeking healthcare for hypertensive symptoms without serious illness [AOR = 2.4, 95% CI: (1.28, 4.56)] were significantly associated with developing undiagnosed hypertension. Conclusion The study has revealed that one in seven adults had undiagnosed hypertension in the study area. Thus, interventions to prevent hypertension should target increasing awareness among people with a family history of hypertension, controlling excessive alcohol consumption, promoting physical exercise, regulating street food markets, and improving the health-seeking behavior of adults in urban settings.
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Affiliation(s)
- Abebe Suliman
- School of Public Health, Wachemo University, Hossana, Ethiopia
| | - Sebsibe Tadesse
- National Data Management and Analytics Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lonsako Abute
- School of Public Health, Wachemo University, Hossana, Ethiopia
| | - Markos Selamu
- School of Public Health, Wachemo University, Hossana, Ethiopia
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Brennan AT, Vetter B, Masuku SD, Mtshazo B, Mashabane N, Sokhela S, Venter WD, Kao K, Meyer-Rath G. Integration of point-of-care screening for type 2 diabetes mellitus and hypertension into the COVID-19 vaccine programme in Johannesburg, South Africa. BMC Public Health 2023; 23:2291. [PMID: 37986070 PMCID: PMC10662646 DOI: 10.1186/s12889-023-17190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND South Africa grapples with a substantial burden of non-communicable diseases (NCDs), particularly type 2 diabetes (diabetes) and hypertension. However, these conditions are often underdiagnosed and poorly managed, further exacerbated by the strained primary healthcare (PHC) system and the disruptive impact of the COVID-19 pandemic. Integrating NCD screening with large-scale healthcare initiatives, such as COVID-19 vaccination campaigns, offers a potential solution, especially in low- and middle-income countries (LMICs). We investigated the feasibility and effectiveness of this integration. METHODS A prospective cohort study was conducted at four government health facilities in Johannesburg, South Africa. NCD screening was incorporated into the COVID-19 vaccination campaign. Participants underwent COVID-19 rapid tests, blood glucose checks, blood pressure assessments, and anthropometric measurements. Those with elevated blood glucose or blood pressure values received referrals for diagnostic confirmation at local PHC centers. RESULTS Among 1,376 participants screened, the overall diabetes prevalence was 4.1%, combining previously diagnosed cases and newly identified elevated blood glucose levels. Similarly, the hypertension prevalence was 19.4%, comprising pre-existing diagnoses and newly detected elevated blood pressure cases. Notably, 46.1% of participants displayed waist circumferences indicative of metabolic syndrome, more prevalent among females. Impressively, 7.8% of all participants screened were potentially newly diagnosed with diabetes or hypertension. Approximately 50% of individuals with elevated blood glucose or blood pressure successfully linked to follow-up care within four weeks. CONCLUSION Our study underscores the value of utilizing even brief healthcare interactions as opportunities for screening additional health conditions, thereby aiding the identification of previously undiagnosed cases. Integrating NCD screenings into routine healthcare visits holds promise, especially in resource-constrained settings. Nonetheless, concerted efforts to strengthen care linkage are crucial for holistic NCD management and control. These findings provide actionable insights for addressing the NCD challenge and improving healthcare delivery in LMICs.
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Affiliation(s)
- Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | | | - Sithabiso D Masuku
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bukelwa Mtshazo
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkuli Mashabane
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simiso Sokhela
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem Df Venter
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Gesine Meyer-Rath
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Steffen HM, Mahanani MR, Neuhann F, Nhlema A, Kasper P, de Forest A, Chaweza T, Tweya H, Heller T, Chiwoko J, Winkler V, Phiri S. Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study. Clin Res Cardiol 2023; 112:1650-1663. [PMID: 37414923 PMCID: PMC10584708 DOI: 10.1007/s00392-023-02253-w] [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: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial. METHODS Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression. RESULTS 1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%). CONCLUSION Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved. TRIAL REGISTRATION NCT02381275.
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Affiliation(s)
- Hans-Michael Steffen
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- Hypertension Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | | | - Florian Neuhann
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Philipp Kasper
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andrew de Forest
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | | | - Hannock Tweya
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Tom Heller
- Lighthouse Clinic, Lilongwe, Malawi
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | | | - Volker Winkler
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sam Phiri
- Lighthouse Clinic, Lilongwe, Malawi
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi
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Makukule A, Modjadji P, Thovhogi N, Mokgalaboni K, Kengne AP. Uncontrolled Hypertension, Treatment, and Predictors among Hypertensive Out-Patients Attending Primary Health Facilities in Johannesburg, South Africa. Healthcare (Basel) 2023; 11:2783. [PMID: 37893857 PMCID: PMC10606846 DOI: 10.3390/healthcare11202783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Hypertension is a poorly controlled risk factor for cardiovascular disease in South Africa, particularly among patients receiving care in the public sector who are mostly from low socioeconomic backgrounds. This cross-sectional study investigated uncontrolled hypertension, treatment, and predictors among hypertensive out-patients attending primary health care facilities in Johannesburg, South Africa. The WHO STEPwise approach to the surveillance of non-communicable diseases was used to collect data, including sociodemographic and lifestyle factors, health status, and measurements for anthropometry and blood pressure along with self-reported adherence to treatment, estimated through the general medication adherence scale. Uncontrolled hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in diagnosed patients receiving anti-hypertensive treatment. Overweight and obesity were defined as a body mass index ≥25 and ≥30 kg/m2, respectively. Logistic regression models were used to assess the predictors of uncontrolled hypertension. Four hundred (n = 400) hypertensive out-patients (mean age: 50 ± 8 years) participated in this study, with most living in poor sociodemographic environments. The prevalence rate of uncontrolled hypertension was 57%. Obesity (62% vs. 42%, p ≤ 0.0001), salt consumption (90% vs. 55%, p ≤ 0.0001), alcohol intake (42% vs. 19%, p ≤ 0.0001), a smoking habit (23% vs. 4%, p ≤ 0.0001), alternative medicine use (51% vs. 40%, p = 0.043), and comorbidities (64% vs. 36%, p ≤ 0.0001) were higher in the uncontrolled group than the controlled group, whereas the prevalence of physical activity (38% vs. 15%, p ≤ 0.0001) was high in the controlled group vs. the uncontrolled. Overall, 85% of the patients moderately adhered to treatment, only 2% exhibited high adherence, and 13% demonstrated low adherence; over half of the patients received tri-therapy treatment. The predictors of uncontrolled hypertension are a number of prescribed antihypertensive therapies [adjusted odds ration = 2.39; 95% confidence interval: 1.48-3.87], treatment adherence [0.46; 0.21-0.97], salt consumption [28.35; 7.87-102.04], physical activity [0.22; 0.13-0.37], current alcohol use [2.10; 1.22-3.61], and current cigarette smoking [4.79; 1.88-12.18]. The high prevalence of uncontrolled hypertension in this study suggests a need to optimize prescriptions, adherence to BP-lowering medications, and lifestyle modifications. The management of comorbidities such as diabetes could offer considerable benefits in controlling blood pressure.
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Affiliation(s)
- Amaziah Makukule
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, 1 Molotlegi Street, Ga-Rankuwa 0208, South Africa
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Roodepoort 1709, South Africa
| | - Ntevhe Thovhogi
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Roodepoort 1709, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
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Kilindimo SS, Abdulkarim A, Simbila AN, Harrison R, Shirima L, Abdallah F, Mukhtar AG, Mfinanga J, Saika J, Kisanga E, Sawe HR. The burden and management strategies of hypertensive crisis in adult patients presenting to emergency departments of district and regional hospitals in Sub-Saharan Africa. Clin Hypertens 2023; 29:27. [PMID: 37777812 PMCID: PMC10544116 DOI: 10.1186/s40885-023-00251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 09/03/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Hypertensive crisis is among the causes of morbidity and mortality in adult patients with hypertension in Sub-Saharan Africa. We aimed to determine the burden, risk factors and describe the management strategies of hypertensive crisis among adult patients seen at emergency departments of district and regional hospitals in Tanzania. METHODS This was a prospective multicenter longitudinal study which included all 162 district and regional hospitals in Tanzania. It was part of the Tanzania Emergency Care Capacity Survey (TECCS), a large assessment of burden of acute illness and emergency care capacity in Tanzania. Adult patients who presented to emergency departments with blood pressure ≥ 180/110mmHg were enrolled. Demographics, clinical presentation, management, and 24-hours outcomes were recorded using a structured case report form. Descriptive statistics were summarized in frequency and median, while logistic regression was used to evaluate the association between risk factors and presence of hypertensive crisis. RESULTS We screened 2700 patients and enrolled 169 adults, henceforth proportion of adult patients with hypertensive crisis was 63 per 1000. Median age was 62 years (IQR 50-70 years) and predominantly females, 112 (66.3%). Majority 151(89.3%) were self-referred with two-wheel motorcycle being the commonest 46 (27.2%) mode of arrival to the hospital. Hypertensive emergency was found in over half 96 (56.8%) of the patients with hypertensive crisis, with oral medications administered in more than half of them, 71 (74%) as means to control the high blood pressure, and one-third 33 (34.4%) were discharged home. On multivariate analysis increasing age (AOR 4.53, p < 0.001), use of illicit drug (AOR 4.14, p-0.04) and pre-existing hypertension (AOR 8.1, p < 0.001) were independent risk factors for hypertensive crisis occurrence. CONCLUSION Hypertensive crisis among adult patients attending district and regional hospitals is common (63 patients per every 1000 patients). Increasing age, use of illicit drug and pre-existing hypertension are independent associated factors for developing hypertensive crisis.
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Affiliation(s)
- Said S Kilindimo
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania.
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Ahmed Abdulkarim
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Alphonce N Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Raynald Harrison
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Lucy Shirima
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Farida Abdallah
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Aliasghar G Mukhtar
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Juma Mfinanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Joseph Saika
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Emanuel Kisanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Ibrahim UM, Jibo AM, Muazu S, Zubairu Z, Ringim SU, Namadi FA, Ringim SH, Buba LF, Jalo RI, Tsiga-Ahmed FI, Abdulsalam K, Karkarna MZ. Factors associated with hypertension among adults in high burden kidney disease areas of Jigawa State, Nigeria: A cross-sectional survey. Niger Postgrad Med J 2023; 30:275-284. [PMID: 38037783 DOI: 10.4103/npmj.npmj_214_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background Hypertension is the leading risk factor for preventable cardiovascular-related complications and mortalities worldwide. Materials and Methods A cross-sectional survey was conducted to assess the prevalence and factors associated with hypertension among 361 adults from four local government areas (LGAs) of Jigawa state identified to have high burden of kidney diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed and data were analysed using IBM SPSS version 22.0. Results The age of the respondents ranged from 18 to 102 years with a median of 45 (interquartile range = 30-80) years. More than a quarter (34.9%) of the respondents were unemployed. Few reported history of alcohol ingestion (0.8%) and cigarette smoking (1.1%). The prevalence of systolic hypertension was 116 (32.1%), while that of diastolic hypertension was 133 (36.8%). Jahun LGA had higher cases (36.7%) of systolic hypertension, whereas Dutse LGA had higher cases (47.8%) of diastolic hypertension. Systolic hypertension was significantly higher (P < 0.001) among those >35 years of age. The odds of developing systolic hypertension were significantly lower among those between the ages of 18 and 35 years, and those between the ages of 18 and 35 years were less likely to have systolic hypertension than those above the age of 35 years (adjusted odds ratio = 9.0; 95% confidence interval = 4.6-17.6). Similarly, those who reported family history of diabetes and hypertension (P < 0.001) had a significantly higher proportion of systolic hypertension. Conclusions The prevalence of hypertension was alarming in the high burden kidney disease areas. The government should develop a sustainable model for the mass community screening of risk factors and community-based health insurance for the effective management of all identified cases.
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Affiliation(s)
| | - Abubakar Mohammed Jibo
- Department of Community Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Salisu Muazu
- Department of Internal Medicine, Federal University Dutse, Dutse, Jigawa, Nigeria
| | - Zahrau Zubairu
- Department of Nursing Science, Hemodialysis Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Saadatu Uba Ringim
- Department of Public Health, Texila American University, Georgetown, Guyana, Niger
| | | | - Sadiq Hassan Ringim
- Department of Internal Medicine, Rasheed Shekoni Teaching Hospital, Dutse, Jigawa, Nigeria
| | - Luka Fitto Buba
- Department of Environmental Management, Bayero University Kano, Kano, Nigeria
| | - Rabiu Ibrahim Jalo
- Department of Community Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Kabiru Abdulsalam
- Department of Chemical Pathology and Immunology, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
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Jobe M, Mactaggart I, Hydara A, Kim MJ, Bell S, Badjie O, Bittaye M, Perel P, Prentice AM, Burton MJ. Evaluating the hypertension care cascade in middle-aged and older adults in The Gambia: findings from a nationwide survey. EClinicalMedicine 2023; 64:102226. [PMID: 37767194 PMCID: PMC10520336 DOI: 10.1016/j.eclinm.2023.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Background Hypertension is a major public health problem in sub-Saharan Africa with poor treatment coverage and high case-fatality rates. This requires assessment of healthcare performance to identify areas where intervention is most needed. To identify areas where health resources should be most efficiently targeted, we assessed the hypertension care cascade i.e., loss and retention across the various stages of care, in Gambian adults aged 35 years and above. Methods This study was embedded within the nationally representative 2019 Gambia National Eye Health Survey of adults ≥35 years. We constructed a hypertension care cascade with four categories: prevalence of hypertension (defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, and/or current use of medication prescribed for hypertension); those aware of their diagnosis; those treated; and those with a controlled blood pressure (defined as blood pressure <140/90 mmHg). Analyses were age- and sex-standardised to the population structure of The Gambia. Logistic regression was used to assess the socio-demographic factors associated with prevalence, awareness, treatment and control of hypertension. Findings Of 9171 participants with data for blood pressure, the prevalence of hypertension was 47.0%. Among people with hypertension, the prevalence of awareness was 54.7%, the prevalence of hypertension treatment was 32.5%, and prevalence of control was 10.0% with little difference between urban and rural residence. The cascade of care performance was better in women. However, there was no difference in achieving blood pressure control between men and women who were receiving treatment. Female sex, older age and higher body mass index were associated with higher hypertension awareness whilst having an occupation compared to being unemployed was associated with higher odds of being treated. Patients in the underweight category had higher odds of achieving blood pressure control. Interpretation There is a high prevalence of hypertension and low performance of the health care system that impact on the hypertension care cascade among middle-aged and older adults in The Gambia. Addressing the full cascade will be paramount especially in reducing the mounting prevalence and improving diagnosis of patients with hypertension, where the greatest dividends will be gained. Funding The Queen Elizabeth Diamond Jubilee Trust, Wellcome Trust.
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Affiliation(s)
- Modou Jobe
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, UK
| | - Abba Hydara
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | - Min J. Kim
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Suzannah Bell
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Omar Badjie
- Directorate of Health Promotion & Education, Ministry of Health, The Gambia
| | - Mustapha Bittaye
- Directorate of Health Services, Ministry of Health, The Gambia
- Department of Obstetrics and Gynaecology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Boachie-Ansah P, Anto BP, Marfo AFA, Dassah ET, Cobbold CC, Asiamah M. Prevalence, Awareness, and Control of Hypertensive Disorders amongst Pregnant Women Seeking Healthcare in Ghana. J Pregnancy 2023; 2023:4194443. [PMID: 37732166 PMCID: PMC10508994 DOI: 10.1155/2023/4194443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
Hypertensive disorders in pregnancy (HDPs) are no longer seen as "transitory diseases cured by delivery." It accounts for up to 50% of maternal deaths. Information concerning HDPs is less in developing countries like Ghana. This study was conducted to find out the prevalence, awareness, risk factors, control, and the birth outcomes of HDPs. This was a retrospective cohort study conducted among pregnant women seeking care in selected health facilities in the Ashanti Region. Data on demographics, HDPs, and its associated birth outcomes were collected. Logistic regression models were used to examine the association of the independent variables with HDPs. The burden of HDPs was 37.2% among the 500 mothers enrolled with chronic hypertension superimposed with preeclampsia accounting for 17.6%, chronic hypertension, 10.2%, and preeclampsia 6.8% whilst gestational hypertension was 2.6%. It was observed that 44% (220) of the mothers had excellent knowledge on HDPs. Oral nifedipine and methyldopa were frequently used for HDP management, and it resulted in a significant reduction in HDP burden from 37.2% to 26.6%. Factors that influenced the increased risk of HDPs were grand multigravida (AOR = 4.53; CI = 1.42-14.42), family history of hypertension (AOR = 3.61; CI = 1.89-6.90), and the consumption of herbal preparations (AOR = 2.92; CI = 1.15-7.41) and alcohol (AOR = 4.10; CI = 1.34-12.62) during pregnancy. HDPs increased the risk of preterm delivery (AOR = 2.66; CI = 1.29-5.89), stillbirth (AOR = 12.47; CI = 2.72-57.24), and undergoing caesarean section (AOR = 1.70; CI = 1.10-2.61) amongst mothers during delivery. The burden of HDPs is high amongst pregnant mothers seeking care in selected facilities. There is the need for intensified campaign on HDPs in the Ashanti Region of Ghana.
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Affiliation(s)
- Pauline Boachie-Ansah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Berko Panyin Anto
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Tieru Dassah
- Department of Population and Family Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Constance Caroline Cobbold
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
| | - Morrison Asiamah
- Department of Electron Microscopy and Histopathology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
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Ndede KO, Khan Z, Akumiah FK, Wanyoike M. A Retrospective Five-Year Study of Cardiovascular Risk Assessment and Risk-Based Interventions Among Hypertensive Patients in Nairobi Hospital, Kenya. Cureus 2023; 15:e46097. [PMID: 37900475 PMCID: PMC10611917 DOI: 10.7759/cureus.46097] [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] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Cardiovascular disease (CVD) is a leading cause of global morbidity and mortality. It is projected that the prevalence of CVD will continue to rise in developing countries, largely driven by an increase in the prevalence of potentially modifiable risk factors. Atherosclerotic cardiovascular risk assessment among individuals with risk factors for CVD but without CVD is an inexpensive and viable strategy in CVD risk stratification and prevention. Despite the known benefits of CVD risk assessment, it is not well established whether physicians/ cardiologists in Kenya comply with the guideline-recommended practice of CVD risk stratification as a prerequisite for initiation of primary CVD preventive interventions. Aims and objectives This study was designed to audit the utilization of cardiovascular risk assessment tools in risk stratification of hypertensive individuals and physician provision of risk-based primary CVD prevention interventions. Results A five-year (2017-2022) retrospective study of patients' medical records was conducted in December 2022 at the PrimeCare cardiology clinic in Nairobi Hospital, Kenya. Data were collected from 373 patients' medical records retrospectively. The data were analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). The mean age of the patients was 60 years with the majority being female (54%). The mean BMI was 30.3 kg/m2 while the mean systolic and diastolic pressure was 140mmHg and 80mmHg, respectively. Only 2.1% of participants were current smokers. The national or alternative guideline-recommended CVD risk assessment tool was used in 0.3% and 2.4%, respectively. The 10-year CVD risk score was documented in only 1.3%. The majority of the participants (93%) had low CVD risk. Half of the patients were taking statins for primary prevention while > 60% of them had been offered therapeutic lifestyle advice. Conclusion The study revealed poor compliance with guideline-recommended CVD risk assessment tools and documentation of the CVD risk level. However, there was above-average adherence to documentation of therapeutic lifestyle measures for primary CVD prevention.
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Affiliation(s)
- Kevin O Ndede
- Internal Medicine/Medical Physiology, Kenya Methodist University, Nairobi, KEN
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Bart's Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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Yao KH, Diopoh SP, Konan SD, Guehi MC, Kamagate S, Ouattara K, Moudachirou MIA. Prevalence and Risk Factors of Chronic Kidney Disease in the General Population in Abidjan, Côte d'Ivoire: A Cross-sectional Study. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:427-436. [PMID: 38995301 DOI: 10.4103/1319-2442.397204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Chronic kidney disease (CKD) is a major cause of morbidity and mortality worldwide, but few studies are available on CKD in Cote d'Ivoire. We aimed to assess the prevalence of CKD and identify its associated factors in the general population in Abidjan in 2016 in a cross-sectional study that included 1418 subjects. We did not receive laboratory data for 38 subjects, including serum creatinine data. Of the 1380 remaining subjects, 138 cases of CKD were included in the study (10% prevalence). We observed a female predominance (sex ratio = 0.81), and the mean age was 43.7 ± 14.5 years. Histories of hypertension (HTN) (29.7%) and diabetes (10.1%) were reported. The main clinical signs were high blood pressure (51.4%), obesity (21%), proteinuria (37.9%), and hematuria (37.4%). The glomerular filtration rate (GFR) was <60 mL/min in 8.2% of cases according to the Modification of Diet in Renal Disease equation, in 8.6% according to the CKD Epidemiology Collaboration equation, and in 12.6% according to the Cockroft-Gault (CG) equation. The other laboratory signs were hyperglycemia (51.4%), hypercholesterolemia (34.1%), and hyperlipidemia (21%). In the multivariate analysis, factors such as female sex (P = 0.013), age >55 years (P = 0.02), a history of HTN (P = 0.001), hypercholesterolemia (P = 0.010), and hyperlipidemia (P = 0.009) were associated with the risk of CKD. The prevalence of CKD was high in our study. The CG equation should not be used to estimate the GFR in the general population. Prevention involves managing modifiable risk factors.
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Affiliation(s)
- Kouamé Hubert Yao
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Sery Patrick Diopoh
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Serge Didier Konan
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Monlet Cyr Guehi
- Department of Nephrology, University Hospital of Yopougon, Abidjan, Côte d'Ivoire
| | - Sira Kamagate
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Kolo Ouattara
- Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d'Ivoire
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Shehu MN, Adamu UG, Ojji DB, Ogah OS, Sani MU. The Pandemic of Coronary Artery Disease in the Sub-Saharan Africa: What Clinicians Need to Know. Curr Atheroscler Rep 2023; 25:571-578. [PMID: 37606811 DOI: 10.1007/s11883-023-01136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally with an accelerated increase in CVD‑related death in Africa and other low‑middle‑income countries. This review is aimed at highlighting the burden of coronary artery disease CAD, its peculiarities as well as challenges of management in sub-Saharan Africa. RECENT FINDINGS Recent data revealed a shift from high incidence of CVDs associated with poverty and malnutrition (such as rheumatic heart disease) initially, which are now falling, to rising incidence of other non-communicable CVDs (such as hypertension, coronary artery disease (CAD), and heart failure). Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide, which is projected to supersede communicable diseases in the future. Previous studies have shown that CAD was rare among Africans. Those studies conducted in Africa in the 1940s-1960s reported that Black Africans were almost immune to developing CAD and were even thought to have specific genetic make-up protecting them from CAD. However, the continent is now experiencing a steady rise in the prevalence of CAD associated with severe disease burden, compared to other regions of the world. The changes seen have been attributed to the current epidemiological transition with increase in CVD risk factors that are poorly controlled, lack of awareness as well as the poor health facilities to tackle the menace of the disease. The Global Burden of Disease (GBD) estimates have also shown that over the past three decades the highest contribution to CVD burden in Africa is attributed to atherosclerotic diseases, with 71.4, 37.7, and 154% increases in the burden of ischemic heart disease, stroke, and peripheral artery disease respectively. There is a steady increase of CAD prevalence in Africa as a result of increase in CV risk factors. Hypertension, obesity, diabetes, dyslipidemia, and cigarette smoking are the rapidly rising risk factors for CAD on the continent. Africa also faces challenges in diagnosis and management of CAD. There is need for increased public and health personnel awareness on prevention and control of commonly identifiable risk factors, provision of prehospital emergency services, and provision of modern therapeutic facilities for treatment of CAD including reperfusion therapy. These are priority areas where efforts could be intensified in the future with potential to improve the current rate of progress of the disease on the continent.
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Affiliation(s)
- Muhammad N Shehu
- Department of Internal Medicine, General Amadi Rimi Specialist Hospital Katsina, Batagarawa, Nigeria
| | - Umar G Adamu
- Department of Internal Medicine, Federal Medical Centre, Bida, Niger State, Nigeria
| | - Dike B Ojji
- Department of Internal Medicine, University of Abuja, Teaching Hospital, Abuja, Nigeria
| | - Okechukwu S Ogah
- Department of Internal Medicine, University College Hospital, Ibadan, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria.
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Phiri N, Cunningham Y, Witek-Mcmanus S, Chabwera M, Munthali-Mkandawire S, Masiye J, Saka A, Katundulu M, Chiphinga Mwale C, Dembo Kang’ombe D, Kimangila J, Crampin AC, Mair FS. Development and piloting of a primary school-based salt reduction programme: Formative work and a process evaluation in rural and urban Malawi. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000867. [PMID: 37647266 PMCID: PMC10468067 DOI: 10.1371/journal.pgph.0000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 06/27/2023] [Indexed: 09/01/2023]
Abstract
Excess salt intake is a major modifiable risk factor for cardiovascular disease. Promoting salt reduction as part of routine school-health programming may be a pragmatic way to address this risk factor early in the life course but has not been tested in sub-Saharan Africa (SSA). Here we describe the formative work with stakeholders and process evaluation of pilot work to develop a school-based salt reduction programme for children aged 11-14 years, in preparation for a cluster-randomised trial in rural/urban Malawi. Collection of observational data and documentary evidence (meeting minutes/field notes) from the earliest key stakeholder engagement with Malawi Ministries of Health, Education, Local Government and Rural Development and Malawi Institute of Education, and non-governmental stakeholders; and a series of semi-structured interviews and focus groups (with head teachers (n = 2); teachers (n = 4); parents (n = 30); and learners (n = 40)). Data was analysed thematically and conceptualised through a Normalization Process Theory lens. Formative work illustrated a range of administrative, technical, and practical issues faced during development of the programme; including allocation of stakeholder roles and responsibilities, harmonisation with pre-existing strategies and competing priorities, resources required for programme development, and design of effective teaching materials. While participants were positive about the programme, the process evaluation identified features to be refined including perceived challenges to participation, recommended adaptations to the content and delivery of lessons, and concerns related to quantity/quality of learning resources provided. This study demonstrates the importance of comprehensive, sustained, and participatory stakeholder engagement in the development of a novel school health programme in SSA; and highlights the factors that were critical to successfully achieving this. We also demonstrate the value of detailed process evaluation in informing development of the programme to ensure that it was feasible and relevant to the context prior to evaluation through a cluster-randomised trial.
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Affiliation(s)
- Nozgechi Phiri
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Yvonne Cunningham
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stefan Witek-Mcmanus
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Department of Population Heath, Faculty of Epidemiology & Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - McDonald Chabwera
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | | | | | | | | | | | | | - Amelia C. Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
- Department of Population Heath, Faculty of Epidemiology & Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Frances S. Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Keino BC, Carrel M. Spatial and temporal trends of overweight/obesity and tobacco use in East Africa: subnational insights into cardiovascular disease risk factors. Int J Health Geogr 2023; 22:20. [PMID: 37620831 PMCID: PMC10463724 DOI: 10.1186/s12942-023-00342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is increasing in Sub-Saharan Africa (SSA). Overweight/obesity and tobacco use are modifiable CVD risk factors, however literature about the spatiotemporal dynamics of these risk factors in the region at subnational or local scales is lacking. We describe the spatiotemporal trends of overweight/obesity and tobacco use at subnational levels over a 13-year period (2003 to 2016) in five East African nations. METHODS Cross-sectional, nationally representative Demographic and Health Surveys (DHS) were used to explore the subnational spatiotemporal patterns of overweight/obesity and tobacco use in Burundi, Kenya, Rwanda, Tanzania, and Uganda, five East African Community (EAC) nations with unique cultural landscapes influencing CVD risk factors. Adaptive kernel density estimation and logistic regression were used to determine the spatial distribution and change over time of CVD risk factors on a subnational and subpopulation (rural/urban) scale. RESULTS Subnational analysis shows that regional and national level analysis masks important trends in CVD risk factor prevalence. Overweight/obesity and tobacco use trends were not similar: overweight/obesity prevalence increased across most nations included in the study and the inverse was true for tobacco use prevalence. Urban populations in each nation were more likely to be overweight/obese than rural populations, but the magnitude of difference varied widely between nations. Spatial analysis revealed that although the prevalence of overweight/obesity increased over time in both urban and rural populations, the rate of change differed between urban and rural areas. Rural populations were more likely to use tobacco than urban populations, though the likelihood of use varied substantially between nations. Additionally, spatial analysis showed that tobacco use was not evenly distributed across the landscape: tobacco use increased in and around major cities and urban centers but declined in rural areas. CONCLUSIONS We highlight the importance of de-homogenizing CVD risk factor research in SSA. Studies of national or regional prevalence trends mask important information about subpopulation and place-specific behavior and drivers of risk factor prevalence. Spatially explicit studies should be considered as a vital tool to understand local drivers of health, disease, and associated risk factor trends, especially in highly diverse yet low-resourced, marginalized, and often homogenized regions.
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Affiliation(s)
- Barbara Chebet Keino
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA.
| | - Margaret Carrel
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA
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Hassan AA, Abdelbagi O, Osman OE, Adam I. Association between serum 25-hydroxyvitamin D concentrations and hypertension among adults in North Sudan: a community-based cross-sectional study. BMC Cardiovasc Disord 2023; 23:402. [PMID: 37592222 PMCID: PMC10433536 DOI: 10.1186/s12872-023-03432-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Globally, hypertension represents a major public health problem. The association between 25-hydroxyvitamin D (25[OH]D) levels and hypertension remains unclear. The current study aimed to investigate the association between serum 25(OH)D levels and hypertension among adults in Sudan. METHODS A community-based cross-sectional study was conducted among adults in North Sudan. Sociodemographic and clinical data were collected using a questionnaire and face-to-face interviews. Serum 25(OH)D was measured using an enzyme-linked immunosorbent assay. Multivariate logistic regression and multiple linear regression analyses were performed. RESULTS Of the total of 391 participants, 202 (51.7%) were females. The median (interquartile range [IQR]) of participants' ages was 45(32-55) years. Of the total, 219(56.0%) had hypertension. The median (IQR) of serum25(OH)D was 13.3(9.9-19.7) ng/mL, and 295 (75.4%) participants had vitamin D deficiency (< 20 ng/mL). In multivariable logistic regression, the adjusted odds ratio (AOR) for age = 1.05, 95% confidence interval (CI)1.03‒1.061, the AOR for being female = 2.02, 95% CI, 1.12‒3.66, and body mass index was AOR = 1.09, 95% CI, 1.05‒1.14, all of which were significantly associated with hypertension. However, serum 25(OH)D levels were not associated with hypertension (AOR = 1.01, 95% CI 0.99‒1.05, P = 0.317). In multiple linear regression, while systolic blood pressure was negatively associated with 25(OH)D (coefficient = - 0.28, P = 0.017), there was no significant association between serum 25(OH)D level and diastolic blood pressure (coefficient = - 0.10, P = 0.272) or mean blood pressure (coefficient =-0.03, P = 0.686). CONCLUSION The current study revealed a negative association between vitamin D and systolic blood pressure. The mechanism of such an association needs further study.
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Affiliation(s)
- Ahmed A. Hassan
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Omer Abdelbagi
- Department of Pathology, AlQunfudhah Faculty of Medicine, Umm Al-Qura University, Al Qunfudhah, Saudi Arabia
| | - Osman E. Osman
- Faculty of Medicine, Alneelain University, Khartoum, Sudan
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Gondwe J, Ndovie M, Khuluza F, Banda CG. Association between HIV and treatment-resistant hypertension in Malawian adults: a protocol for a case-control study. BMJ Open 2023; 13:e069280. [PMID: 37532483 PMCID: PMC10401204 DOI: 10.1136/bmjopen-2022-069280] [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: 10/15/2022] [Accepted: 07/04/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Treatment-resistant hypertension (RH), defined as uncontrolled blood pressure (≥140/90 mm Hg) despite treatment with ≥3 medications of different classes (including diuretics) at optimal doses, is associated with poor prognosis and an elevated risk of end-organ damage. In areas where HIV is endemic, such as sub-Saharan Africa, the risk of hypertension is high in people living with HIV. It remains unknown if HIV infection further increases the risk of RH. This study seeks to determine the association between HIV and RH as well as investigate other factors associated with RH in hypertensive Malawian adults. METHODS AND ANALYSIS A case-control study will be conducted among adult hypertensive patients attending a clinic at a referral hospital in Malawi. The cases will be hypertensive patients with a confirmed diagnosis of RH. For each case, two controls (hypertensive patients without RH), frequency matched for age group and sex, will be selected from among hospital clients attending the same hypertension clinic as the case. In both groups, HIV status will be ascertained. Additionally, information on other potential risk factors of RH, such as chronic kidney disease, obesity, hypercholesteraemia, diabetes, smoking, alcohol use, antiretroviral therapy regimen and duration, will be collected in both cases and controls. For each of the potential risk factors, ORs will be calculated to quantify the strength of their association with RH. In a multivariate analysis, conditional logistic regression will be used to assess the independent association between HIV and RH as well as the influence of the other potential drivers of RH. ETHICS AND DISSEMINATION This protocol has been approved by the College of Medicine Research Ethics Committee (COMREC) in Malawi (P.05/22/3637). Findings from this study will be disseminated through a peer-reviewed publication in an open-access international journal. Furthermore, anonymised data will be available on request from the authors.
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Affiliation(s)
- Josephine Gondwe
- Population Health Theme, Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - Maclean Ndovie
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Felix Khuluza
- Department of Pharmacy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Clifford George Banda
- Population Health Theme, Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
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Traore PWHB, Tine JAD, Bassoum O, Kane A, Faye A. Associated factors with hypertension, known poorly controlled hypertension, and newly diagnosed hypertension among people aged 18-70 in Senegal. J Public Health Afr 2023; 14:2538. [PMID: 37680873 PMCID: PMC10481903 DOI: 10.4081/jphia.2023.2538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/08/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction In this study, we aimed to determine the factors associated with hypertension, known poorly controlled hypertension, and newly diagnosed hypertension in 2015 to improve the prevention of this pathology in our country. Methods This was a secondary analysis of the national WHO STEPwise survey database. It had a quantitative, descriptive, and analytical aim. The sampling was done in stratification in three stages of sampling. Statistical analysis was performed using Rstudio 4.0.2 software. It was a descriptive, bivariate, and multivariate analysis using binomial logistic regression for explanatory purposes. Results The risk factors for being hypertensive among 18-70- year-olds in Senegal in 2015 were: having taken their blood pressure at least once in their life; having taken their cholesterol levels at least once in their life; having received advice to reduce salt consumption; having received advice on how to reduce the amount of sugar; having a lean body mass index; being overweight; being obese III; and being between 35-39 and 65-70 years old. The protective factors are: checking the salt content indicated on the labels; and consuming salt-rich dishes "often" compared to "never". The risk factors for being newly diagnosed with hypertension among 18-70-year-olds in Senegal in 2015 were: having a history of stroke; having a resting heart rate greater than 80 beats per minute; consuming palm oil; and having high fasting blood sugar. The protective factors are: having a high average number of meals eaten per week not prepared at home; checking the salt content indicated on the label; and being of female sex. The risk factors for being known to have poorly controlled hypertension among 18-70- year-olds in Senegal in 2015 were: judging their reduction in salt consumption as "very important"; and having received advice to reduce their salt consumption. The protective factors are: performing physical activity only when traveling; and limiting the consumption of salty meals. Conclusion Senegalese family cooking exposes to hypertension, small actions limiting salt consumption strongly protect against hypertension, and simple physical activity during travel strongly protects against hypertension, but the health system is very little proactive in the primordial and primary prevention of hypertension.
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Affiliation(s)
- Pêngd-Wendé Habib Boussé Traore
- Institute of Health and Development, Public Health Service, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar
- Cardiology Department, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dalal Jamm Hospital, Dakar, Senegal
| | - Jean Augustin Diégane Tine
- Institute of Health and Development, Public Health Service, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar
| | - Oumar Bassoum
- Institute of Health and Development, Public Health Service, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar
| | - Abdoul Kane
- Cardiology Department, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dalal Jamm Hospital, Dakar, Senegal
| | - Adama Faye
- Institute of Health and Development, Public Health Service, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar
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Pandey AR, Poudyal A, Adhikari B, Shrestha N. Burden of chronic kidney disease in Nepal: An analysis of the burden of disease from 1990 to 2019. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001727. [PMID: 37467235 DOI: 10.1371/journal.pgph.0001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/13/2023] [Indexed: 07/21/2023]
Abstract
Chronic kidney disease (CKD) has emerged as one of the major public health concerns. The increasing prevalence of its correlates such as obesity, diabetes, and hypertension has been, due in part responsible for the increased burden. However, very few studies have presented the comprehensive data on burden of disease particularly in developing countries like Nepal. In this study, we have performed an analysis on prevalence, mortality, years lived with disability (YLDs), years of life lost (YLLs) and disability-adjusted life years (DALYs) attributable to CKD in Nepal using Global Burden of Disease (GBD) Study 2019. The GBD 2019 study provides estimation of the prevalence, mortality rates, YLDs, YLLs and DALYs due to 369 different disease and 87 risk factors for 204 countries and territories across the world. In this study, we present Nepal specific data on prevalence, mortality, YLDs, YLLs and DALYs related to CKD. In 2019, there were 1,895,080 prevalent cases of CKD with 5,108 deaths, and a total of 168,900 DALYs were attributable to CKD. Age-standardized prevalence rate of CKD increased from 5,979.1 cases per 100,000 population (95% UI: 5539.7, 6400.4) in 1990 to 7,634.1 cases per 100,000 population (95% UI: 7138.8, 8119.4) in 2019 with higher prevalence in males. Similarly, the age-standardized mortality due to CKD increased for both sexes from 0.8 deaths per 100,000 population (95% UI: 0.6, 1.0) in 1990 to 2.6 deaths per 100,000 population (95% UI: 2.0, 3.3) in 2019. The burden of CKD as a percentage of total DALYs was 0.5% (95% UI: 0.4, 0.6) in 1990 and increased to 1.8% (95% UI: 1.4, 2.2%) in 2019. Kidney dysfunction, high systolic blood pressure, high fasting plasma glucose, high body mass index, low temperature, lead exposure, diet high in sodium, and high temperature were found to be the major risk factors for CKD. The study reveals that Nepal has a high and rising burden of CKD. Innovative strategies for prevention of CKD including health system preparedness for treatment services are required to respond to the rising burden of CKD.
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Affiliation(s)
- Achyut Raj Pandey
- Development and Innovation Department, Research, Health Research and Social Development Forum (HERD), Janakpur, Nepal
| | - Anil Poudyal
- Research Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Bikram Adhikari
- Development and Innovation Department, Research, Health Research and Social Development Forum (HERD), Janakpur, Nepal
| | - Niraj Shrestha
- Research Section, Social Development and Promotion Center, Kathmandu, Nepal
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Feyisa BR, Tamiru A, Debelo S, Feyisa I, Tola EK, Tolesa EJ, Negeri A, Shibiru T, Galata A, Biru B. Magnitude of hypertension and its association with obesity among employees of Wallaga University, Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e070656. [PMID: 37438078 PMCID: PMC10347519 DOI: 10.1136/bmjopen-2022-070656] [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: 12/01/2022] [Accepted: 06/02/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE To determine the magnitude of hypertension, its association with obesity and the associated factors among employees of Wallaga University, Ethiopia. DESIGN, SETTING AND PARTICIPANTS This institution-based cross-sectional study was employed among 588 employees of the university. Respondents were selected by stratified random sampling technique and interviewed with the aid of a structured questionnaire. THE MAIN OUTCOME MEASURED Hypertension and obesity were measured using WHO Stepwise approach and recommendations. We used a stratified random sampling technique to select 588 employees of the university from 3 August 2021 to 15 October 2021. A structured questionnaire and anthropometric measurements were used for data collection. Multivariable logistic regression analysis was used to determine factors independently associated with hypertension. A p value less than or equal to 0.05 and its 95% confidence level was used to declare the statistical significance. RESULTS A total of 578 participants consented and completed the study, giving a response rate of 98.3%. The mean age of the respondents was 31.78 years with SD of 5.4. The overall prevalence of hypertension, general obesity and central obesity was 14.4% (95% CI 11.6% to 17.5%), 31.3% (95% CI 27.6% to 35.3%) and 37% (95% CI 33.1% to 41.1%), respectively. Obesity was significantly associated with hypertension (adjusted OR (AOR): 6.3; 95% CI 2.60 to 8.19). Age range from 35 to 46 (AOR 7.01; 95% CI 1.56 to 31.74), age ≥46 years (AOR 8.45; 95% CI 1.14 to 62.04), being non-academic staff (AOR 2.74; 95% CI 1.56 to 4.81), having additional income (AOR 2.48; 95% CI 1.08 to 5.70), physical inactivity (AOR 2.36; 95% CI 1.44 to 3.88) and poor practice of dietary salt consumption (AOR 1.65; 95% CI 1.01 to 2.87) were factors associated with hypertension. CONCLUSION One in seven, more than two in seven and nearly two in six of the employees of Wallaga University were hypertensive, centrally obese and generally obese, respectively. There was a positive association between obesity and hypertension. Comprehensive awareness creation and devising workplace intervention strategies are highly recommended to reduce the hypertension burden and associated obesity.
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Affiliation(s)
- Bikila Regassa Feyisa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Afework Tamiru
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
- Department of Public Health, College of Medical and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Sidise Debelo
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Ilili Feyisa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Edosa Kifle Tola
- Department of Medical Laboratory Science, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Edosa Jabesa Tolesa
- Sport Studies, College of Computational and Natural Sciences, Wallaga University, Nekemte, Ethiopia
| | - Asefa Negeri
- Institute of Health Sciences, Wallaga University Referral Hospital, Wallaga University, Nekemte, Ethiopia
| | - Tesfaye Shibiru
- Institute of Health Sciences, Wallaga University Referral Hospital, Wallaga University, Nekemte, Ethiopia
| | - Alemtsehay Galata
- Department of Nursing, School of Nursing and Midwifery, Wallaga University, Nekemte, Ethiopia
| | - Bayise Biru
- Department of Public Health, Institutes of Health Sciences, Wallaga University, Nekemte, Ethiopia
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Elias S, Dadi TK. Prevalence of Undiagnosed Hypertension and Associated Factors among Adults in Mizan-Aman Town, Bench Sheko Zone, Southwest Ethiopia: A Community-Based Cross-Sectional Study. Adv Med 2023; 2023:2746284. [PMID: 37469806 PMCID: PMC10352527 DOI: 10.1155/2023/2746284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/27/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
Objectives This study aimed to assess the prevalence of undiagnosed hypertension and associated factors among people aged 18 years and above in Mizan-Aman town of Bench Sheko Zone in Southwest Ethiopia. Study Design. A community-based cross-sectional study design was carried out among people aged 18 years old and above from April 1 to 30, 2021, in Mizan Aman town. Methods A community-based cross-sectional study design was carried out among people aged 18 years old and above from April 1 to 30, 2021, in Mizan Aman town. Seven hundred fifty-nine subjects were selected by the multistage sampling technique. A structured pretested STEPwise questionnaire was used to interview the participants. Data entry and analysis were done using EpiData 3.1 and SPSS version 25 statistical software, respectively. Descriptive analysis was undertaken, and the results were presented using frequency tables, graphs, and statistical summaries. The dependent variable has a dichotomized response of yes and no, and hence binary logistic regression was used to predict a dependent variable based on independent variables, and predictors having p ≤ 0.25 on the bivariable analysis were considered as candidates for the multivariable analysis. Odds ratios with their 95% confidence intervals were calculated to measure the strength of association, and finally a p value <0.05 was considered statistically significant. Result The prevalence of undiagnosed hypertension was 14.8% with 95% CI [12.3-15.6]. Older age (AOR = 3.1, 95% CI [1.5-6.5]), male (AOR = 2.2, 95% CI [1.3-3.9]), low physical activity (AOR = 3.9, 95% CI [1.8-8.3]), low consumption of fruit and vegetable (AOR = 4.5, 95% CI [2.4-8.8]), and higher BMI (AOR = 2.7, 95% CI [1.6-4.6]) were significantly associated with undiagnosed hypertension. Conclusion The current study outlined that the prevalence of undiagnosed hypertension was high in the study area. In addition, most of the risk factors identified were modifiable, and hence community-based preventive approaches like lifestyle modification, increasing awareness, and strengthening routine screening at primary health service facilities resulted in a substantial change in tackling the burden effectively.
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Affiliation(s)
- Sebsibe Elias
- Public Health Department, College of Health Sciences, Mizan-Aman College of Health Science, Mizan-Aman, Ethiopia
| | - Teshome Kabeta Dadi
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Oyando R, Were V, Willis R, Koros H, Kamano JH, Naanyu V, Etyang A, Mugo R, Murphy A, Nolte E, Perel P, Barasa E. Examining the responsiveness of the National Health Insurance Fund to people living with hypertension and diabetes in Kenya: a qualitative study. BMJ Open 2023; 13:e069330. [PMID: 37407061 DOI: 10.1136/bmjopen-2022-069330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To assess the responsiveness of the National Health Insurance Fund (NHIF) Supa Cover benefit package to the needs of individuals with diabetes and hypertension in Kenya. DESIGN, SETTING AND PARTICIPANTS We carried out a qualitative study and collected data using key informant interviews (n=39) and focus group discussions (n=4) in two purposively selected counties in Western Kenya. Study participants were drawn from NHIF officials, county government officials, health facility managers, healthcare workers and individuals with hypertension and diabetes who were enrolled in NHIF. We analysed data using a thematic approach. RESULTS Study participants reported that the NHIF Supa Cover benefit package expanded access to services for people living with hypertension and diabetes. However, the NHIF members and healthcare workers had inadequate awareness of the NHIF service entitlements. The NHIF benefit package inadequately covered the range of services needed by people living with hypertension and diabetes and the benefits package did not prioritise preventive and promotive services. Sometimes patients were discriminated against by healthcare providers who preferred cash-paying patients, and some NHIF-empanelled health facilities had inadequate structural inputs essential for quality of care. Study participants felt that the NHIF premium for the general scheme was unaffordable, and NHIF members faced additional out-of-pocket costs because of additional payments for services not available or covered. CONCLUSION Whereas NHIF has reduced financial barriers for hypertension and diabetes patients, to enhance its responsiveness to patient needs, NHIF should implement mechanisms to increase benefit package awareness among members and providers. In addition, preventive and promotive services should be included in NHIF's benefits package and mechanisms to monitor and hold contracted providers accountable should be strengthened.
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Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Vincent Were
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ruth Willis
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Hillary Koros
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Jemima H Kamano
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Violet Naanyu
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Anthony Etyang
- Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Adrianna Murphy
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Ellen Nolte
- Department of Health Service Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, University of Oxford, Oxford, 01540, UK
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Bayaraa N, Azahar NM, Kitaoka K, Kobayashi Y, Yano Y. African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): a holistic approach for hypertension control in Africa. J Hum Hypertens 2023:10.1038/s41371-023-00845-7. [PMID: 37386123 DOI: 10.1038/s41371-023-00845-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/07/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Nomin Bayaraa
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Division for University Hospital Development, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nazar Mohd Azahar
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
- Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Pulau Pinang, Kampus Bertam, Pulau Pinang, Malaysia
| | - Kaori Kitaoka
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Yusuke Kobayashi
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University, Yokohama, Japan
| | - Yuichiro Yano
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan.
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Xue L, Cai M, Liu Q, Ying X, Wu S. Trends and regional variations in chronic diseases and their risk factors in China: an observational study based on National Health Service Surveys. Int J Equity Health 2023; 22:120. [PMID: 37381035 DOI: 10.1186/s12939-023-01910-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Over the past 25 years, the spectrum of diseases in China has rapidly changed from infectious to non-communicable diseases (NCDs). This study aimed to identify the prevalence of chronic diseases over the past 25 years in China and estimate the trends and changes in risk factors related to NCDs. METHODS We conducted a descriptive analysis based on the National Health Service Survey (NHSS) from 1993 to 2018. The survey year (in parentheses) and its respective number of respondents were (1993) 215,163; (1998) 216,101; (2003) 193,689; (2008) 177,501; (2013) 273,688; and (2018) 256,304. In each survey, approximately half the participants were male. In addition, we estimated the trends in the prevalence and risk factors of NCDs from 1993 to 2018 and described their coefficient of variation in the provisions. RESULTS The prevalence of NCDs has risen rapidly, from 17.0% in 1993 to 34.3% 2018. Hypertension and diabetes were the two main NCDs accounting for 53.3% in 2018. Similarly, the prevalence of hypertension and diabetes have also increased rapidly, increasing 15.1 and 27.0 times respectively from 1993 to 2018. Moreover, from 1993 to 2018, the proportion of smoking decreased from 32.0% to 24.7%, and the proportion of drinking and physical activity increased from 18.4% and 8.0% to 27.6% and 49.9%, respectively. The proportion of obesity increased from 5.4% in 2013 to 9.5% in 2018. The prevalence of NCDs in rural areas (35.2%) in 2018 was slightly higher than that in urban areas (33.5%). Changes in the prevalence of NCDs in rural were larger than those in urban. However, from 2013 to 2018, the provincial gaps for these metrics narrowed, except for that of smoking (Coefficient of Variation from 0.14 to 0.16). CONCLUSIONS The prevalence of NCDs increased rapidly in China and was similar in urban and rural areas in 2018. Two key risk factors (drinking and obesity) increased in prevalence, while the other two (smoking and physical inactivity) decreased. These results indicate that China is facing considerable challenges in curbing chronic diseases to achieve the United Nations Sustainable Development Goals or the Healthy China 2030 goals. The government should take more active measures to change unhealthy lifestyles, improve efficiency in risk factor management, and pay more attention and allocate more health resources to rural areas.
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Affiliation(s)
- Long Xue
- Huashan Hospital, Fudan University, Shanghai, China
| | - Min Cai
- Center of Health Statistics and Information, National Health Commission, 1 Xizhimen Wai Nan Lu, Xicheng District, Beijing, China
| | - Qinqin Liu
- Center of Health Statistics and Information, National Health Commission, 1 Xizhimen Wai Nan Lu, Xicheng District, Beijing, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, 138 Medical College Road, Shanghai, China.
| | - Shiyong Wu
- Center of Health Statistics and Information, National Health Commission, 1 Xizhimen Wai Nan Lu, Xicheng District, Beijing, China.
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Byiringiro S, Ogungbe O, Commodore-Mensah Y, Adeleye K, Sarfo FS, Himmelfarb CR. Health systems interventions for hypertension management and associated outcomes in Sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001794. [PMID: 37289741 DOI: 10.1371/journal.pgph.0001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023]
Abstract
Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores the health system interventions on hypertension management and associated outcomes in SSA. The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and October 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for the risk of bias using the tools from the Joanna Briggs Institute. Twelve studies clustered in 8 SSA countries met the inclusion criteria. Two thirds (8/12) of the included studies had low risk of bias. Most interventions focused on health workforce factors such as providers' knowledge and task shifting of hypertension care to unconventional health professionals (n = 10). Other health systems interventions addressed the supply and availability of medical products and technology (n = 5) and health information systems (n = 5); while fewer interventions sought to improve financing (n = 3), service delivery (n = 1), and leadership and governance (n = 1) aspects of the health systems. Health systems interventions showed varied effects on blood pressure outcomes but interventions targeting multiple aspects of health systems were likely associated with improved blood pressure outcomes. The general limitations of the overall body of literature was that studies were likely small, with short duration, and underpowered. In conclusion, the literature on health systems internventions addressing hypertension care are limited in quantity and quality. Future studies that are adequately powered should test the effect of multi-faceted health system interventions on hypertension outcomes with a special focus on financing, leadership and governance, and service delivery interventions since these aspects were least explored.
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Affiliation(s)
- Samuel Byiringiro
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Khadijat Adeleye
- University of Massachusetts, Amherst, MA, United States of America
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ashanti Region, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ashanti Region, Ghana
| | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Ambaw Kassie G, Alemu A, Yosef Gebrekidan A, Asmare Adella G, Eshetu K, Wolie Asres A, Sisay Asgedom Y. Undiagnosed hypertension and associated factors among adults in ethiopia: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:278. [PMID: 37244992 PMCID: PMC10225092 DOI: 10.1186/s12872-023-03300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Hypertension is a major public health problem, resulting in 10 million deaths annually. Undiagnosed hypertension affects more people than ever before. It is more likely to be linked to severe hypertension, which can lead to stroke, cardiovascular disease, and ischemic heart disease. Thus, this systematic review and meta-analysis aimed to synthesize the prevalence of undiagnosed hypertension and its associated factors in Ethiopia. METHODS Databases, such as Medline/PubMed, Google Scholar, Science Direct, AJOL, and the Cochrane Library, were systematically searched to find potential studies published until December 2022. A Microsoft Excel spreadsheet was used to enter the extracted data. The pooled prevalence of undiagnosed hypertension and its associated factors was estimated using a random effect model. I2 statistics and the Cochrane Q-test were used to assess statistical heterogeneity across the studies. Begg's and Egger's tests were performed to identify possible publication bias. RESULTS A total of ten articles with 5,782 study participants were included in this meta-analysis. In the random effects model, the pooled prevalence of undiagnosed hypertension was 18.26% (95% CI = 14.94-21.58). Being older (OR = 3.8, 95% CI = 2.56, 5.66), having a body mass index > 25 kg/m2 (OR = 2.71, 95% CI = 2.1, 3.53), having a family history of hypertension (OR = 2.22, 95% CI = 1.47, 3.36), and having DM comorbidity (OR = 2.44, 95% CI = 1.38, 4.32) were significantly associated with undiagnosed hypertension. CONCLUSION In this meta-analysis, the pooled prevalence of undiagnosed hypertension was found to be high in Ethiopia. Being older, having a BMI > 25 kg/m2, having a family history of hypertension, and having DM comorbidity were found to be risk factors for undiagnosed hypertension.
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Affiliation(s)
- Gizachew Ambaw Kassie
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Afework Alemu
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Eshetu
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abiyot Wolie Asres
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yordanos Sisay Asgedom
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Anto EO, Boadu WIO, Korsah EE, Ansah E, Adua E, Frimpong J, Nyarkoa P, Tamakloe VCKT, Acheampong E, Asamoah EA, Opoku S, Afrifa-Yamoah E, Annani-Akollor ME, Obirikorang C. Unrecognized hypertension among a general adult Ghanaian population: An urban community-based cross-sectional study of prevalence and putative risk factors of lifestyle and obesity indices. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001973. [PMID: 37224164 DOI: 10.1371/journal.pgph.0001973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
Hypertension (HTN) is the leading cause of cardiovascular diseases. Nevertheless, most individuals in developing countries are unaware of their blood pressure status. We determined the prevalence of unrecognized hypertension and its association with lifestyle factors and new obesity indices among the adult population. This community-based study was conducted among 1288 apparently healthy adults aged 18-80 years in the Ablekuma North Municipality, Ghana. Sociodemographic, lifestyle characteristics, blood pressure and anthropometric indices were obtained. The prevalence of unrecognized HTN was 18.4% (237 / 1288). The age groups 45-54 years [aOR = 2.29, 95% CI (1.33-3.95), p = 0.003] and 55-79 years [aOR = 3.25, 95% CI (1.61-6.54), p = 0.001], being divorced [aOR = 3.02 95% CI (1.33-6.90), p = 0.008], weekly [aOR = 4.10, 95% CI (1.77-9.51), p = 0.001] and daily alcohol intake [aOR = 5.62, 95% CI (1.26-12.236), p = 0.028] and no exercise or at most once a week [aOR = 2.25, 95% CI (1.56-3.66), p = 0.001] were independently associated with HTN. Among males, the fourth quartile (Q4) of both body roundness index (BRI) and waist to height ratio (WHtR) [aOR = 5.19, 95% CI (1.05-25.50), p = 0.043] were independent determinants of unrecognized HTN. Among females, the third quartile (Q3) [aOR = 7.96, 95% CI (1.51-42.52), p = 0.015] and Q4 [aOR = 9.87 95% CI (1.92-53.31), p = 0.007] of abdominal volume index (AVI), the Q3 of both BRI and WHtR [aOR = 6.07, 95% CI (1.05-34.94), p = 0.044] and Q4 of both BRI and WHtR [aOR = 9.76, 95% CI (1.74-54.96), p = 0.010] were independent risk factors of HTN. Overall, BRI (AUC = 0.724) and WHtR (AUC = 0.724) for males and AVI (AUC = 0.728), WHtR (AUC = 0.703) and BRI (AUC = 0.703) for females yielded a better discriminatory power for predicting unrecognized HTN. Unrecognized hypertension is common among the apparently healthy adults. Increased awareness of its risk factors, screening, and promoting lifestyle modification is needed to prevent the onset of hypertension.
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Affiliation(s)
- Enoch Odame Anto
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medical and Health Sciences, Edith Cowan University, Joondalup Drive, Perth, Australia
- Centre for Precision Health, ECU Strategic Research Centre, Edith Cowan University, Perth, Australia
| | - Wina Ivy Ofori Boadu
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Ekow Korsah
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ezekiel Ansah
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Adua
- Rural Clinical School, Medicine and Health, University of New South Wales, Sydney, NSW Australia
| | - Joseph Frimpong
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Patience Nyarkoa
- Department of Physiology, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Emmanuel Acheampong
- Centre for Precision Health, ECU Strategic Research Centre, Edith Cowan University, Perth, Australia
| | - Evans Adu Asamoah
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen Opoku
- Faculty of Allied Health Sciences, Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Max Efui Annani-Akollor
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medicine and Dentistry, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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