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Chiramal JA, Johnson J, Webster J, Nag DR, Robert D, Ghosh T, Golla S, Pawar S, Krishnan P, Drain PK, Mooney SJ. Artificial Intelligence-based automated CT brain interpretation to accelerate treatment for acute stroke in rural India: An interrupted time series study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003351. [PMID: 39047001 PMCID: PMC11268585 DOI: 10.1371/journal.pgph.0003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/19/2024] [Indexed: 07/27/2024]
Abstract
In resource-limited settings, timely treatment of acute stroke is dependent upon accurate diagnosis that draws on non-contrast computed tomography (NCCT) scans of the head. Artificial Intelligence (AI) based devices may be able to assist non-specialist physicians in NCCT interpretation, thereby enabling faster interventions for acute stroke patients in these settings. We evaluated the impact of an AI device by comparing the time to intervention (TTI) from NCCT imaging to significant intervention before (baseline) and after the deployment of AI, in patients diagnosed with stroke (ischemic or hemorrhagic) through a retrospective interrupted time series analysis at a rural hospital managed by non-specialists in India. Significant intervention was defined as thrombolysis or antiplatelet therapy in ischemic strokes, and mannitol for hemorrhagic strokes or mass effect. We also evaluated the diagnostic accuracy of the software using the teleradiologists' reports as ground truth. Impact analysis in a total of 174 stroke patients (72 in baseline and 102 after deployment) demonstrated a significant reduction of median TTI from 80 minutes (IQR: 56·8-139·5) during baseline to 58·50 (IQR: 30·3-118.2) minutes after AI deployment (Wilcoxon rank sum test-location shift: -21·0, 95% CI: -38·0, -7·0). Diagnostic accuracy evaluation in a total of 864 NCCT scans demonstrated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) in detecting intracranial hemorrhage to be 0·89 (95% CI: 0·83-0·93), 0·99 (0·98-1·00), 0·96 (0·91-0·98) and 0·97 (0·96-0·98) respectively, and for infarct these were 0·84 (0·79-0·89), 0·81 (0·77-0·84), 0·58 (0·52-0·63), and 0·94 (0·92-0·96), respectively. AI-based NCCT interpretation supported faster abnormality detection with high accuracy, resulting in persons with acute stroke receiving significantly earlier treatment. Our results suggest that AI-based NCCT interpretation can potentially improve uptake of lifesaving interventions for acute stroke in resource-limited settings.
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Affiliation(s)
- Justy Antony Chiramal
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Jacob Johnson
- Department of Medicine, Baptist Christian Hospital, Mission Chariali, Tezpur, Assam, India
| | - Jemin Webster
- Department of Medicine, Baptist Christian Hospital, Mission Chariali, Tezpur, Assam, India
| | - D. Rachel Nag
- Department of Medicine, Baptist Christian Hospital, Mission Chariali, Tezpur, Assam, India
| | - Dennis Robert
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Tamaghna Ghosh
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Satish Golla
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Saniya Pawar
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Pranav Krishnan
- Qure.ai Technologies Pvt. Ltd. Raheja Platinum, Andheri East, Mumbai, India
| | - Paul K. Drain
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America
- Department of Global Health, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Stephen J. Mooney
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, United States of America
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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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Stewart S, Mocumbi AO. What does the future hold for youth in Africa with high blood pressure? THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:86-87. [PMID: 38070532 DOI: 10.1016/s2352-4642(23)00309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 01/21/2024]
Affiliation(s)
- Simon Stewart
- Instituto Nacional de Saúde, Marracuene, Mozambique; Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Ana O Mocumbi
- Instituto Nacional de Saúde, Marracuene, Mozambique; Universidade Eduardo Mondlane, Maputo, Mozambique
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Ackah M, Ameyaw L, Appiah R, Owiredu D, Boakye H, Donaldy W, Yarfi C, Abonie US. 30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002769. [PMID: 38241232 PMCID: PMC10798456 DOI: 10.1371/journal.pgph.0002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/01/2024] [Indexed: 01/21/2024]
Abstract
Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.
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Affiliation(s)
- Martin Ackah
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
| | - Louise Ameyaw
- Department of Medicine, Achimota Government Hospital, Accra, Ghana
| | - Richard Appiah
- Faculty of Health and Life Sciences Northumbria University University, Department of Psychology, Newcastle upon Tyne, United Kingdom
- Department of Occupational therapy, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - David Owiredu
- Centre for Evidence synthesis, University of Ghana, Accra, Ghana
| | - Hosea Boakye
- Department of Physiotherapy, LEKMA Hospital, Accra, Ghana
| | | | - Comos Yarfi
- Department of Physiotherapy, University of Allied and Health Sciences, Ho, Ghana
| | - Ulric S. Abonie
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
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Kalita J, Bharadwaz MP, Aditi A. Prevalence, contributing factors, and economic implications of strokes among older adults: a study of North-East India. Sci Rep 2023; 13:16880. [PMID: 37803041 PMCID: PMC10558533 DOI: 10.1038/s41598-023-43977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023] Open
Abstract
Stroke is a significant cause of mortality and disability in India, with its economic impact on the rise. This study aims to investigate the prevalence and factors associated with stroke among the elderly population in seven north-eastern states of India and its economic consequences. Data from the initial phase of the Longitudinal Ageing Study in India (2017-2018) were utilized, and bivariate and multivariate analyses were done. Stroke prevalence (1.53%) was notable among both genders, with approximately 1% in females and 2.3% in males. Individuals with low physical activity, higher socio-economic status, and unemployment faced a higher risk of stroke. Females exhibited a 60% lower likelihood [AOR 0.40; (CI 0.250-0.627)] of stroke compared to males and hypertension was a significant risk factor. Stroke patients incur up to INR 50,000 of financial burden, with a considerable proportion facing disability in comprehension and speech. The economic burden of stroke-related hospitalization was significantly high, emphasizing the need for government-funded health insurance to cover stroke-related medications and reducing out-of-pocket expenses for patients seeking treatment in healthcare facilities. The study highlights the urgency for better schemes to address the growing threat of strokes in the north-eastern parts of India for comprehensively tackling this public health challenge.
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Affiliation(s)
- Jumi Kalita
- Lalit Chandra Bharali College, Guwahati, Assam, India
| | | | - Aditi Aditi
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, 400088, India.
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Chen A, Waite L, Mocumbi AO, Chan YK, Beilby J, Ojji DB, Stewart S. Elevated blood pressure among adolescents in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 2023; 11:e1238-e1248. [PMID: 37474231 DOI: 10.1016/s2214-109x(23)00218-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries. However, there is a paucity of data on the pattern of elevated blood pressure among adolescents aged 10-19 years in sub-Saharan Africa. We aimed to provide pooled estimates of high blood pressure prevalence and mean levels in adolescents aged 10-19 years across sub-Saharan Africa. METHODS In this systematic review and meta-analysis, we searched PubMed, Google Scholar, African Index Medicus, and Embase to identify studies published from Jan 1, 2010, to Dec 31, 2021. To be included, primary studies had to be observational studies of adolescents aged 10-19 years residing in sub-Saharan African countries reporting the pooled prevalence of elevated blood pressure or with enough data to compute these estimates. We excluded studies on non-systemic hypertension, in African people not living in sub-Saharan Africa, with participant selection based on the presence of hypertension, and with adult cohorts in which we could not disaggregate data for adolescents. We independently extracted relevant data from individual studies using a standard data extraction form. We used a random-effects model to estimate the pooled prevalence of elevated blood pressure and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels overall and on a sex-specific basis. This study is registered with PROSPERO (CRD42022297948). FINDINGS We identified 2559 studies, and assessed 81 full-text studies for eligibility, of which 36 studies comprising 37 926 participants aged 10-19 years from ten (20%) of 49 sub-Saharan African countries were eligible. A pooled sample of 29 696 adolescents informed meta-analyses of elevated blood pressure and 27 155 adolescents informed meta-analyses of mean blood pressure. Sex data were available from 26 818 adolescents (14 369 [53·6%] were female and 12 449 [46·4%] were male) for the prevalence of elevated blood pressure and 23 777 adolescents (12 864 [54·1%] were female and 10 913 [45·9%] were male) for mean blood pressure. Study quality was high, with no low-quality studies. The reported prevalence of elevated blood pressure ranged from 4 (0·2%) of 1727 to 1755 (25·1%) of 6980 (pooled prevalence 9·9%, 95% CI 7·3-12·5; I?=99·2%, pheterogeneity<0·0001). Mean SBP was 111 mm Hg (95% CI 108-114) and mean DBP was 68 mm Hg (66-70). 13·4% (95% CI 12·9-13·9; pheterogeneity<0·0001) of male participants had elevated blood pressure compared with 11·9% (11·3-12·4; pheterogeneity<0·0001) of female participants (odds ratio 1·04, 95% CI 0·81-1·34; pheterogeneity<0·0001). INTERPRETATION To our knowledge, this systematic review and meta-analysis is the first systematic synthesis of blood pressure data specifically derived from adolescents in sub-Saharan Africa. Although many low-income countries were not represented in our study, our findings suggest that approximately one in ten adolescents have elevated blood pressure across sub-Saharan Africa. Accordingly, there is an urgent need to improve preventive heart-health programmes in the region. FUNDING None.
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Affiliation(s)
| | - Laura Waite
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Ana O Mocumbi
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Justin Beilby
- Torrens University Australia, Adelaide, SA, Australia
| | - Dike B Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa; Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
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Okekunle AP, Jones S, Adeniji O, Watkins C, Hackett M, Di Tanna GL, Owolabi M, Akinyemi R. Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates. Int J Stroke 2023; 18:634-644. [PMID: 36503371 PMCID: PMC10313746 DOI: 10.1177/17474930221147164] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of stroke (a leading cause of disability and mortality) in Africa appears to be increasing, but a systematic review of the best available data to support or refute this observation is lacking. AIM To determine the incidence and 1-month case-fatality rates from high-quality studies of stroke epidemiology among Africans. SUMMARY OF REVIEW We searched and retrieved eligible articles on stroke epidemiology among indigenous Africans in bibliographic databases (MEDLINE, ScienceDirect, Google Scholar, and Cochrane library) using predefined search terms from the earliest records through January 2022. Methodological assessment of eligible studies was conducted using the Newcastle-Ottawa scale. Pooling of incidence and case-fatality rates was performed via generalized linear models (Poisson-Normal random-effects model). Of the 922 articles retrieved, 14 studies were eligible for inclusion. The total number of stroke cases was 2568, with a population denominator (total sample size included in population-based registries or those who agreed to participate in door-to-door community studies) of 3,384,102. The pooled crude incidence rate of stroke per 100,000 persons in Africa was 106.49 (95% confidence interval (CI) = 58.59-193.55), I2 = 99.6%. The point estimate of the crude incidence rate was higher among males, 111.33 (95% CI = 56.31-220.12), I2 = 99.2%, than females, 91.14 (95% CI = 47.09-176.37), I2 = 98.9%. One-month case-fatality rate was 24.45 (95% CI = 16.84-35.50), I2 = 96.8%, with lower estimates among males, 22.68 (95% CI = 18.62-27.63), I2 = 12.9%, than females, 27.57 (95% CI = 21.47-35.40), I2 = 51.6%. CONCLUSION The burden of stroke in Africa remains very high. However, little is known about the dynamics of stroke epidemiology among Africans due to the dearth of high-quality evidence. Further continent-wide rigorous epidemiological studies and surveillance programs using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework are needed.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | | | - Olaleye Adeniji
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | | | - Maree Hackett
- University of Central Lancashire, Preston, UK
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Innovative Technologies, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus Akinyemi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Peng S, Liu X, Cao W, Liu Y, Liu Y, Wang W, Zhang T, Guan X, Tang J, Zhang Q. Global, regional, and national time trends in mortality for stroke, 1990-2019: An age-period-cohort analysis for the global burden of disease 2019 study and implications for stroke prevention. Int J Cardiol 2023:S0167-5273(23)00652-6. [PMID: 37150213 DOI: 10.1016/j.ijcard.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Despite the fact that stroke is the second leading cause of death globally, a comprehensive and comparable assessment of mortality, and epidemiologic trends has not been conducted for most regions.We estimated the global and regional burden of stroke from 1990 to 2019 using data from the 2019 Global Study of Diseases, Injuries, and Risk Factors. METHODS For the period between 1990 and 2019, we used an age-period-cohort model to calculate the annual percentage changes in mortality (net drifts), local drifts, and period and cohort relative risks (period/cohort effects). Meanwhile, to quantify the temporal trends in stroke age-standardised mortality rate (ASMR), Average annual percentage changes (AAPCs) were determined by sex, area. With the potential to uncover disparities and treatment gaps in stroke care, this approach enables the examination and differentiation of age, period, and cohort effects in mortality trends. FINDINGS Global stroke deaths in 2019 were 6,552,725 (95% UI 5,995,200 to 7,015,139). Between 1990 and 2019, the ASMR declined globally by 36.43% (95% UI -41.65 to -31.2), with decreases in all SDI quintiles. The net drift in stroke mortality from 1990 to 2019 varied from -2.83% per year (95% confidence interval [CI]:-3.39 to -2.77) in countries with a high Socio-demographic Index (SDI) to -1.21% per year (95% CI: -1.26 to -1.16) in countries with a low SDI. During the past 30 years, favorable mortality reductions were generally found in high-SDI countries (net drift = -3.1% [95% CI: -3.4 to -2.8] per year) and high-middle SDI countries (-2.8% [-3.0 to -2.6]). However, 31 of 204 countries had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥ - 0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high and high-middle SDI countries, with the exceptions of Kuwait, Ukraine, Kazakhstan, Guam, RussianFederation, Lithuania, Turkey, Montenegro, Serbia, Bosnia and Herzegovin, and Bulgaria. INTERPRETATION Notwithstanding mortality from stroke has increased globally over the past 30 years, adverse period and cohort effects have been found in many countries, calling into question the adequacy of healthcare for stroke patients of all ages. These lapses have a significant impact on the likelihood of achieving the Sustainable Development Goal (SDG) targets on mortality from age 60+ and NCDs.
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Affiliation(s)
- Shengxian Peng
- Scientific Research Department, First People's Hospital of Zigong City, Zigong, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenzhai Cao
- Department of Cardiology, First People's Hospital of Zigong City, Zigong, China
| | - Yue Liu
- Scientific Research Department, First People's Hospital of Zigong City, Zigong, China
| | - Yuan Liu
- Scientific Research Department, First People's Hospital of Zigong City, Zigong, China
| | - Wei Wang
- Information Department, First People's Hospital of Zigong City, Zigong, China
| | - Ting Zhang
- Scientific Research Center,Sichuan Vocational College of Health and Rehabilitation, Zigong, China
| | - Xiaoyan Guan
- Scientific Research Department, First People's Hospital of Zigong City, Zigong, China
| | - Juan Tang
- Scientific Research Department, First People's Hospital of Zigong City, Zigong, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
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The Burden and In-Hospital Mortality of Stroke Admissions at a Tertiary Level Hospital in Namibia: A Retrospective Cohort Study. Stroke Res Treat 2023; 2023:1978536. [PMID: 36777446 PMCID: PMC9908341 DOI: 10.1155/2023/1978536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/25/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Background Despite stroke being a leading cause of morbidity and mortality globally, there is a dearth of information on the burden and outcomes of stroke in sub-Saharan Africa and Namibia in particular. Methods A hospital-based, retrospective cohort study was conducted to analyse non-electronic medical records of all consecutive stroke patients who were admitted to one of the highest tertiary-level hospitals in Namibia for 12 months (2019-2020). The primary outcome of the study was to establish the in-hospital mortality, stroke subtypes, and associated complications. Results In total, 220 patients were included in the study, their mean age was 53 (SD13.8) years, and 55.5% were males. 61.0% had an ischaemic stroke (IS), and 39.0% had a haemorrhagic stroke (HS). The mean age was significantly lower in patients with HS vs. IS (48.2 ± 12.2 vs. 56.1 ± 13.3, p < 0.001). Of the IS patients, the majority (29.0%) had total anterior circulation infarct (TACI), while in the HS group, 34.0% had basal ganglia haemorrhage with or without intraventricular extension. Hypertension (p = 0.015), dyslipidaemia (p = 0.001), alcohol consumption (p = 0.022), and other cardiovascular diseases (p = 0.007) were more prevalent in patients with IS compared to those with HS. The prevalence rate of intravenous thrombolysis was 2.2% in IS and use of intravenous antihypertensives in 25.9% of patients with HS than IS. The in-hospital mortality was 26.4% with complications such as raised ICP, aspiration pneumonia, hydrocephalus, and sepsis significantly high in those that died. Aspiration pneumonia (OR 2.79, 95% CI 1.63-4.76, p < 0.001) and increased ICP (OR 0.30, 95% CI 0.16-057, p < 0.001) were independent predictors of in-hospital mortality on the multivariate analysis. Conclusion Our findings showed a younger mean age for stroke and mortality rate comparable to other low- to middle-income countries (LMICs). Hypertension and alcohol consumption were the main risk factors for both stroke subtypes, while aspiration pneumonia and raised intracranial pressure predicted in-hospital mortality.
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Empowering Frontline Primary Healthcare Workers in a Global Health Partnership Training of Trainers Intervention to Strengthen the Prevention and Control of Cardiovascular Disease in Mozambique. Glob Heart 2022; 17:51. [PMID: 36051314 PMCID: PMC9354556 DOI: 10.5334/gh.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/30/2022] [Indexed: 11/20/2022] Open
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Jørgensen JMA, Christensen DL, Nielsen KK, Sadiq HS, Khan MY, Jusabani AM, Walker R. Incidence and characteristics of stroke in Zanzibar–a hospital-based prospective study in a low-income island population. Front Neurol 2022; 13:931915. [PMID: 35968303 PMCID: PMC9366665 DOI: 10.3389/fneur.2022.931915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStroke in adults is a critical clinical condition and a leading cause of death and disability globally. Epidemiological data on stroke in sub-Saharan Africa are limited. This study describes incidence rates, stroke types and antecedent factors among patients hospitalized with stroke in Zanzibar.MethodsThis was a prospective, observational study of stroke patients at hospitals in Unguja, Zanzibar. Socioeconomic and demographic data were recorded alongside relevant past medical history, medicine use and risk factors. The modified National Institute of Health Stroke Scale (mNIHSS) was used to assess admission stroke severity and, when possible, stroke was confirmed by neuroimaging.ResultsA total of 869 stroke admissions were observed from 1st October 2019 through 30th September 2020. Age-standardized to the World Health Organization global population, the yearly incidence was 286.8 per 100,000 adult population (95%CI: 272.4–301.9). Among these patients, 720 (82.9%) gave consent to participate in the study. Median age of participants was 62 years (53–70), 377 (52.2%) were women, and 463 (64.3%) had a first-ever stroke. Known stroke risk factors included hypertension in 503 (72.3%) patients, of whom 279 (55.5%) reported regularly using antihypertensive medication, of whom 161 (57.7%) had used this medication within the last week before stroke onset. A total of 460 (63.9%) participants had neuroimaging performed; among these there was evidence of intracerebral hemorrhage (ICH) in 140 (30.4%). Median stroke severity score using mNIHSS was 19 (10–27).ConclusionZanzibar has high incidence of hospitalization for stroke, indicating a very high population incidence of stroke. The proportion of strokes due to ICH is substantially higher than in high-income countries. Most stroke patients had been in contact with health care providers prior to stroke onset and been diagnosed with hypertension. However, few were using antihypertensive medication at the time of stroke onset.www.ClinicalTrial.gov registration NCT04095806.
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Affiliation(s)
- Jutta M. Adelin Jørgensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Mnazi Mmoja Referral Hospital, Zanzibar, Tanzania
- *Correspondence: Jutta M. Adelin Jørgensen
| | | | | | | | - Muhammad Yusuf Khan
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ahmed M. Jusabani
- Radiology Department, The Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Richard Walker
- Department of Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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12
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Ojji DB, Shedul GL, Sani M, Ogah OS, Dzudie A, Barasa F, Mondo C, Ingabire PM, Jones ESW, Rayner B, Albertino D, Ogola E, Smythe W, Hickman N, Francis V, Shahiemah P, Shedul G, Aje A, Sliwa K, Stewart S. A Differential Response to Antihypertensive Therapy in African Men and Women: Insights From the CREOLE Trial. Am J Hypertens 2022; 35:551-560. [PMID: 35134817 DOI: 10.1093/ajh/hpac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/29/2021] [Accepted: 02/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We sought to address the paucity of data to support the evidence-based management of hypertension to achieve optimal blood pressure (BP) control on a sex-specific basis in Africa. METHODS We undertook a post hoc analysis of the multicenter, randomized CREOLE (Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans) Trial to test the hypothesis that there would be clinically important differences in office BP control between African men and women. We compared the BP levels of 397 and 238 hypertensive women (63%, 50.9 ± 10.5 years) and men (51.2 ± 11.3 years) from 10 sites across sub-Saharan Africa who completed baseline and 6-month profiling according to their randomly allocated antihypertensive treatment. RESULTS Overall, 442/635 (69.6%) participants achieved an office BP target of <140/90 mm Hg at 6 months; comprising more women (286/72.0%) than men (156/65.5%) (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.07-2.39; P = 0.023). Women randomized to amlodipine-hydrochlorothiazide (HCTZ) (adjusted OR 3.03, 95% CI 1.71-5.35; P < 0.001) or amlodipine-perindopril (adjusted OR 2.62, 95% CI 1.49-4.58; P = 0.01) were more likely to achieve this target compared with perindopril-HCTZ. Among men, there were no equivalent treatment differences-amlodipine-HCTZ (OR 1.54, 95% CI 0.76-3.12; P = 0.23) or amlodipine-perindopril (OR 1.32, 95% CI 0.65-2.67; P = 0.44) vs. perindopril-HCTZ. Among the 613 participants (97%) with 24-hour ambulatory BP monitoring, women had significantly lower systolic (124.1 ± 18.1 vs. 127.3 ± 16.9; P = 0.028) and diastolic (72.7 ± 10.4 vs. 75.1 ± 10.5; P = 0.007) BP levels at 6 months compared with men. CONCLUSIONS These data suggest clinically important differences in the therapeutic response to antihypertensive combination therapy among African women compared with African men.
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Affiliation(s)
- Dike B Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja & University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria
| | - Gabriel L Shedul
- Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria.,Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Mahmoud Sani
- Department of Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Okechukwu S Ogah
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Anastase Dzudie
- Department of Medicine, Douala General Hospital, Douala, Cameroon
| | - Felix Barasa
- Department of Medicine, MOI University Hospital, Eldoret, Kenya
| | - Charles Mondo
- Department of Medicine, St Francis Hospital, Nsambya, Kampala, Uganda
| | | | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Brian Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Damasceno Albertino
- Department of Medicine, Eduardo Mondlane University Hospital, Maputo, Mozambique
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Wynand Smythe
- Department of Pharmacy, Life St. Vincent Pallotti Hospital in Cape Town, Cape Town, South Africa
| | - Nicky Hickman
- Clinical Research Centre, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Veronica Francis
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Pandie Shahiemah
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Akinyemi Aje
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Institute for Health Research, University of Notre Dame, Australia, Fremantle, Australia
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NOUR MAHMED, MRABET S, MAIDAL MALI, GHARBI A, ABIDA Y, SOUISSI A, GARGOURI A, KACEM I, NASRI A, GOUIDER R. Stroke in Djibouti. Afr J Emerg Med 2022; 12:141-147. [PMID: 35462861 PMCID: PMC9020134 DOI: 10.1016/j.afjem.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/03/2021] [Accepted: 03/16/2022] [Indexed: 11/28/2022] Open
Abstract
Sub-Saharan Africa is experiencing an increasing burden of stroke, with current prevalence as high as 1.46 per 1000 population. Limited cohort studies exist to profile the epidemiological, clinical and paraclinical characteristics of stroke in this setting. Identifying the most at-risk population for ischemic and haemorrhagic stroke can improve approaches for prevention in this setting.
Background Stroke is a neurological emergency affecting both developed and developing countries. In Djibouti, stroke is the fourth leading cause of death. Our objective was to describe the demographic, clinical, paraclinical profile of stroke in Djibouti and identify the possible underlying risk factors. Methods We conducted a cross-sectional multicentre study carried out over a period of 6 months in the medical services of the Soudano-Djibouti military hospital, the General Peltier hospital and the emergency department of the National fund for social security health centre. Results A total of seventy patients were included. The mean age was 59.61 years with a male predominance (sex ratio: 2.5) and a statistically significant female-related difference beyond the age of 60 years (p <10−3). Cardiovascular risk factors were mainly hypertension (73%), khat chewing (64%) and tobacco use (50%). Khat chewing and tobacco use were associated with a younger age of occurrence of stroke (p=0.020 and p=0.004, respectively). Diabetes mellitus and hypercholesterolemia were found respectively in 30% and 19% of cases, and were more associated with ischemic stroke. Coronary disease (11%), heart failure (3%) and obesity (4%) (significantly associated with the female gender; p= 0,021) were less common. Motor deficits (94%) were the most common clinical manifestations, followed by sensory deficits (51%) and alteration of consciousness (37%). Stroke was ischemic in 61.5% of patients. The most affected territory in ischemic stroke was the territory of the middle cerebral artery, and capsulo-thalamic involvement in haemorrhagic stroke which was significantly associated with the alteration of consciousness(p=0,003). Discussion Stroke had primarily modifiable risk factors in Djiboutian patients dominated by high blood pressure, tobacco use and khat chewing especially in the male population under the age of 60 years. These findings could have implications on future preventive measures and a better approach to public health policy.
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Affiliation(s)
- Mohamed AHMED NOUR
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
- Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, TUNIS, TUNISIA
- Clinical Investigation Center (CIC), Razi University Hospital, Manouba, TUNIS, TUNISIA
- Neurology consultation, National fund for social security health center, Djibouti
| | - Saloua MRABET
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
- Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, TUNIS, TUNISIA
- Clinical Investigation Center (CIC), Razi University Hospital, Manouba, TUNIS, TUNISIA
| | - Mouled ALI MAIDAL
- Neurology consultation, National fund for social security health center, Djibouti
| | - Alya GHARBI
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
- Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, TUNIS, TUNISIA
- Clinical Investigation Center (CIC), Razi University Hospital, Manouba, TUNIS, TUNISIA
| | - Youssef ABIDA
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
| | - Amira SOUISSI
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
- Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, TUNIS, TUNISIA
- Clinical Investigation Center (CIC), Razi University Hospital, Manouba, TUNIS, TUNISIA
| | - Amina GARGOURI
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
- Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, TUNIS, TUNISIA
- Clinical Investigation Center (CIC), Razi University Hospital, Manouba, TUNIS, TUNISIA
| | - Imen KACEM
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
- Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, TUNIS, TUNISIA
- Clinical Investigation Center (CIC), Razi University Hospital, Manouba, TUNIS, TUNISIA
| | - Amina NASRI
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
- Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, TUNIS, TUNISIA
- Clinical Investigation Center (CIC), Razi University Hospital, Manouba, TUNIS, TUNISIA
- Corresponding authors.
| | - Riadh GOUIDER
- Neurology Department, Razi University Hospital, Manouba, TUNIS, TUNISIA
- Faculty of Medicine of Tunis, University of Tunis El Manar, La Rabta, TUNIS, TUNISIA
- Clinical Investigation Center (CIC), Razi University Hospital, Manouba, TUNIS, TUNISIA
- Corresponding authors.
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14
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Cisse FA, Ligot N, Conde K, Barry DS, Toure LM, Konate M, Soumah MF, Diawara K, Traore M, Naeije G. Predictors of stroke favorable functional outcome in Guinea, results from the Conakry stroke registry. Sci Rep 2022; 12:1125. [PMID: 35064178 PMCID: PMC8782910 DOI: 10.1038/s41598-022-05057-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Low- to middle-income countries (LMICs) now bear most of the stroke burden. In LMICs, stroke epidemiology and health care systems are different from HICs. Therefore, a high-income country (HIC)-based predictive model may not correspond to the LMIC stroke context. Identify the impact of modifiable variables in acute stroke management in Conakry, Guinea as potential predictors of favorable stroke outcome. Data were extracted from the Conakry stroke registry that includes 1018 patients. A logistic regression model was built to predict favorable stroke outcomes, defined as mRS 0–2. Age, admission NIHSS score, mean arterial blood pressure and capillary glycemia were chosen as covariates. Delay to brain CT imaging under 24 h from symptom onset, fever, presence of sores and abnormal lung auscultation were included as factors. NIHSS score on admission, age and ischemic stroke were included in the null model as nuisance parameters to determine the contribution of modifiable variables to predict stroke favorable outcome. Lower admission NIHSS, brain CT imaging within 24 h of symptoms onset and lower mean arterial blood pressure emerged as a significant positive predictors of favorable stroke outcome with respective odd ratios (OR) of 1.35 [1.28–1.43], 2.1 [1.16–3.8] and 1.01 [1.01–1.04]. The presence of fever or sores impacted negatively stroke favorable outcomes with OR of 0.3 [0.1–0.85] and 0.25 [0.14–0.45]. The area under receiver operating characteristic curves (AUC) of the model was 0.86. This model explained 44.5% of the variability of the favorable stroke outcome with 10.2% of the variability explained by the modifiable variables when admission NIHSS, and ischemic stroke were included in the null model as nuisance parameter. In the Conakry stroke registry, using a logistic regression to predict stroke favorable outcome, five variables that led to an AUC of 0.86: admission NIHSS, early brain CT imaging, fever, sores and mean blood pressure. This paves the way for future public health interventions to test whether modulating amendable variables leads to increased favorable stroke outcomes in LMICs.
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Affiliation(s)
- Fode Abass Cisse
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Noémie Ligot
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kaba Conde
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Djigué Souleymane Barry
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Lamine Mohamed Toure
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mamadi Konate
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mohamed Fode Soumah
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Karinka Diawara
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mohamed Traore
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Gilles Naeije
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium. .,Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), 808 Lennik Street, 1070, Brussels, Belgium.
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15
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Gebreegziabher BG, Birhanu TE, Olana DD, Tesfaye BT. Characteristics and Risk Factors Associated with Stroke Subtypes among Adult Patients Admitted to the Stroke Unit of Jimma University Medical Center: A Retrospective Cross-sectional Study. Curr Hypertens Rev 2021; 17:67-74. [PMID: 31755395 DOI: 10.2174/1573402115666191121120228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/21/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Almost 80% of deaths due to non-communicable diseases occur in lowand middle-income countries. Stroke is a great public health problem in Ethiopia. Stroke mortality was estimated to be 14.7% in Ethiopia. Despite this, researches done in Ethiopia on factors associated with stroke sub-types were inadequate. OBJECTIVE To assess the characteristics and risk factors associated with stroke subtypes among patients admitted to Jimma University Medical Center. MATERIALS AND METHODS A retrospective cross-sectional study was conducted from May 2017 to May 2018 in the stroke unit of the Jimma University Medical Center. A total of 106 medical charts of patients diagnosed with stroke were reviewed. A checklist comprising relevant variables was used to collect data. SPSS version 21 was employed for data entry and analysis. Pearson chi-square test was used to check the association of different parameters with stroke subtypes. A P-value <0.05 was used as a cutoff point to declare statistical significance. Data were presented using text, tables, and figures. RESULTS From a total of 106 patients, 67 (63.2%) were men. The mean ± SD of age was 52.67±12.46 Year's, and the difference was not significant among stroke subtypes. Among all patients, 59 (55.6%) had ischemic strokes and 47 (44.4%) had hemorrhagic strokes. The most prevalent risk factors significantly associated with stroke subtypes were being male 67 (63.2%) followed by dyslipidemia 43 (40.5%) and cigarette smoking 38 (35.8%). CONCLUSION The ischemic stroke was reported to be higher than hemorrhagic in this study. The overall mean (±SD) age of the patient was 52.67±(12.46) years. The mean age of hemorrhagic stroke patients was 55.98 (±13.77) years; while in ischemic stroke was 50.03 (±10.70) years. Being male, a history of cigarette smoking, and dyslipidemia were significantly associated with stroke subtypes.
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Affiliation(s)
- Bekalu G Gebreegziabher
- Department of Biomedical Sciences, College of Medical Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Tesema E Birhanu
- Department of Biomedical Sciences, College of Medical Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Diriba D Olana
- Department of Biomedical Sciences, College of Medical Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Behailu T Tesfaye
- Department of Clinical Pharmacy, College of Health Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
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16
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Namale G, Kamacooko O, Makhoba A, Mugabi T, Ndagire M, Ssanyu P, Ddamulira J, Yperzeele L, Cras P, Ddumba E, Seeley J, Newton R. HIV sero-positivity and risk factors for ischaemic and haemorrhagic stroke in hospitalised patients in Uganda: A prospective-case-control study. PUBLIC HEALTH IN PRACTICE 2021; 2:100128. [PMID: 36101575 PMCID: PMC9461590 DOI: 10.1016/j.puhip.2021.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 03/01/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives We examined HIV sero-positivity and risk factors in patients admitted with ischaemic stroke (IS) and haemorrhagic stroke (HS) in Kampala, Uganda. Study design We conducted a matched case-control study between December 2016 and December 2018 at St Francis Hospital, Nsambya. Methods The study population comprised of stroke cases (adults aged ≥18 years with IS or HS confirmed by neuroimaging) and controls (age- and sex-matched stroke-free adults aged ≥18 years who were recruited from the same hospital as the cases). A comprehensive assessment for sociodemographic, lifestyle and clinical factors was performed using the World Health Organization (WHO) STEP-wise approach to Surveillance (STEPS) for stroke risk factor surveillance. We used conditional logistic regression to identify risk factors associated with IS or HS. Results We enrolled 137 matched case-control pairs; 48 (35%) were men, and the mean ages were 62.4 years (SD ± 14.8) for cases and 61.1 years (SD ± 14.1) for controls. Of stroke patients, 86 (63%) had IS and 51 (37%) had HS. Overall, HIV sero-positivity was 10% among stroke cases versus 7% among controls. HIV sero-positivity was not significantly associated with stroke (unadjusted odds ratio [uOR] = 1.49, 95% confidence interval [CI] 0.59-3.78). A self-reported family history of diabetes mellitus was associated with an increased risk of all stroke (adjusted odds ratio [aOR] = 4.41, 95% CI 1.47-13.2), as well as for IS and HS separately (aOR = 3.66, 95% CI 1.09-12.4 and aOR = 4.99, 95% CI 1.02-24.4, respectively). High blood pressure (≥140/90 mmHg) was associated with an increased risk of all stroke (aOR = 12.3, 95% CI 42-44.1), and this was also true for IS and HS individually (aOR = 6.48, 95% CI 1.15-36.7 and aOR = 5.63, 95% CI 1.74-18.2, respectively). Conclusions No association was found between HIV sero-positivity and stroke occurrence among Ugandan stroke patients. Hypertension and a self-reported family history of diabetes mellitus were significant risk factors for both IS and HS. Interventions to reduce hypertension and diabetes mellitus in the Ugandan population are urgently required. Much larger studies are required to demonstrate if any association exists between HIV and stroke.
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Affiliation(s)
- G. Namale
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,Corresponding author. MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.
| | - O. Kamacooko
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - A. Makhoba
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - T. Mugabi
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - M. Ndagire
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - P. Ssanyu
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - J.B.M. Ddamulira
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - L. Yperzeele
- University of Antwerp, Department of Neurology, Antwerp, Belgium
| | - P. Cras
- University of Antwerp, Department of Neurology, Antwerp, Belgium
| | - E. Ddumba
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - J. Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,London School of Hygiene &Tropical Medicine, London, UK
| | - R. Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,University of York, York, UK
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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18
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Damien C, Cisse F, Ligot N, Toure ML, Konaté M, Barry SD, Saw M, Naeije G. Insights in the pathophysiology of haemorrhagic strokes in a sub-Sahara African country, an epidemiological and MRI study. Trop Med Int Health 2020; 26:166-172. [PMID: 33159424 DOI: 10.1111/tmi.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Intra-cerebral Haemorrhage (ICH) seems more prevalent in sub-Saharan Africa (SSA) than in High-Income Countries (HIC) with poorer clinical outcome. Higher impact of hypertension and/or amyloid angiopathy could account for this disproportion. Here, we sought to (i) retrospectively compare ICH clinical and imaging patterns in Belgium and Guinea and in a subsequent cohort (ii) prospectively compare brain MRI characteristics to seek evidence for a different proportion of amyloid angiopathy patterns. METHODS Ninety one consecutive patients admitted for spontaneous ICH at Brussels Erasme-ULB Hospital and at Conakry Ignace Deen-UGANC were retrospectively compared in terms of ICH volume estimated with the ABC/2 method, clinical characteristics and modified ranking (mRS) score at 30 days. mRS was dichotomised as good outcomes (≤3) and poor outcomes (>3). A prospective cohort of 30 consecutive patients with ICH admitted at CHU Conakry Ignace Deen-UGANC was prospectively included to undergo brain MRI. Results of the Guinean MRI were compared to 30 patients randomly selected from Brussels' initial cohort. Paired Student's t-test and Mann-Whitney u-test were used for group comparisons. RESULTS Age of ICH onset was higher in Belgium (68 ± 17 years vs. 56 ± 14 years, P < 0.01) while ICH volume and 30-day mortality rate were higher in Guinea (20 ml vs. 11 ml, P < 0.01 and mortality 33% vs. 10 %, P < 0.01). ICH burden in survivors in Conakry and Brussels showed respectively good outcomes in 56.7% and 60.4% (P = 0.09) and poor outcomes in 10.3% vs. 29.6% (P < 0.001). MRI analysis of the prospective cohort failed to disclose significant differences regarding brain MRI characteristics. CONCLUSIONS Intra-cerebral Haemorrhage affected patients 15 years younger in Guinea with larger haematoma volumes and higher mortality than in Belgium. MRI findings did not show more prevalent amyloid angiopathy pathology suggesting that better primary prevention of hypertension could positively impact ICH epidemiology in Guinea.
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Affiliation(s)
- C Damien
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - F Cisse
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - N Ligot
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M L Toure
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - M Konaté
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - S D Barry
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry, Conakry, Guinea
| | - M Saw
- Centre de Diagnostic Caisse Nationale de Sécurité Sociale, Conakry, Guinea
| | - G Naeije
- Department of Neurology, CUB Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study. Ann Med Surg (Lond) 2020; 60:293-300. [PMID: 33204420 PMCID: PMC7649580 DOI: 10.1016/j.amsu.2020.10.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/25/2020] [Accepted: 10/25/2020] [Indexed: 12/17/2022] Open
Abstract
Background Stroke data from Sierra Leone is limited, despite the increase in global burden of the disease. The aim of this study was to assess the risk factors, clinical outcomes and predictors of stroke mortality at a tertiary hospital in Freetown, Sierra Leone. Methods This retrospective cohort study was conducted on stroke patients admitted at the Connaught Teaching Hospital between 1st January to December 31, 2018. Clinical data related to stroke, with variables including patients’ demographics, stroke subtype, vascular risk factors, modified Rankin Scale (mRS), and outcomes were documented. In-hospital mortality, associated risk factors and predictors of stroke were determined. The study was approved by the Sierra Leone Ethics and Scientific Review Committee. It was registered under Research Registry https://www.researchregistry.com/browse-the-registry#home/with the unique identifying number researchregistry6009. Result We studied 178 (95 male and 83 female) patients. The mean age was 59.8 ± 14.0 years, median was 58.1years (ranging: 29–88 years). The commonest risk factors were hypertension (84.3%), tobacco smoking (35.9%) and alcohol (31.4%). Ischemic stroke confirmed by CT scan was 76.3%. In-hospital mortality was 34.8% and at discharge, mean modified Rankin Score (mRS) was 3.89 ± 1.62. The independent predictors for stroke mortality were: hypertension [AOR = 2.2; C.I 95%: (1.32–3.80), p = 0.001], previous stroke [AOR = 2.31; C.I 95%: (1.43–5.74), p = 0.001], GCS < 8 [AOR = 6.06; C.I 95%: (3.17–12.79), p < 0.001], clinical diagnosis in the absence of imaging [AOR = 3.11; C.I 95%: (2.1–9.87), p = 0.001], hemorrhagic stroke [AOR = 2.96; C.I 95%: (1.96–9.54), p < 0.001], and aspiration pneumonia [(AOR = 3.03; C.I 95%:(1.44–6.36), p = 0.001]. Women had poorer outcome than men. Conclusion This study highlights a high stroke mortality in a resource limited hospital, with some stroke patients having difficulties in accessing Computer Tomogram (CT) scan services. It illustrates the need to establish a stroke care setting to improve the quality of stroke care. Globally, sub-Saharan Africa (SSA) has the highest incidence and case-fatality from stroke. In Sierra Leone, the dearth of stroke data limits the access to evidence-based standards of stroke care. We reported a high in-hospital stroke mortality, with majority of the deaths occurring in the first week, and this is comparable to some reported studies from SSA. The poor control of hypertension and aspiration pneumonia are major but avoidable contributors to poor stroke outcomes in SSA.
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Pandian JD, Kalkonde Y, Sebastian IA, Felix C, Urimubenshi G, Bosch J. Stroke systems of care in low-income and middle-income countries: challenges and opportunities. Lancet 2020; 396:1443-1451. [PMID: 33129395 DOI: 10.1016/s0140-6736(20)31374-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/18/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022]
Abstract
The burden of stroke is higher in low-income and middle-income countries (LMICs) than in high-income countries and is rising. Even though there are global policies and guidelines for implementing stroke care, there are many challenges in setting up stroke services in LMICs. Despite these challenges, there are many models of stroke care available in LMICs-eg, multidisciplinary team care led by a stroke neurologist, specialist-led care by neurologists, physician-led care, hub and spoke models incorporating stroke telemedicine (ie, telestroke), and task sharing involving community health workers. Alternative strategies have been developed, such as reorganising the existing hospital infrastructure by training health professionals to implement protocol-driven care. The future challenge is to identify what elements of organised stroke care can be implemented to make the largest gain. Simple interventions such as swallowing assessments, bowel and bladder care, mobility assessments, and consistent secondary prevention can prove to be key elements to improving post-discharge morbidity and mortality in LMICs.
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Affiliation(s)
- Jeyaraj D Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India.
| | | | | | - Cynthia Felix
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerard Urimubenshi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jackie Bosch
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Fekadu G, Chelkeba L, Melaku T, Tegene E, Kebede A. 30-day and 60-day rates and predictors of mortality among adult stroke patients: Prospective cohort study. Ann Med Surg (Lond) 2020; 53:1-11. [PMID: 32274016 PMCID: PMC7132118 DOI: 10.1016/j.amsu.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/03/2020] [Accepted: 03/15/2020] [Indexed: 01/01/2023] Open
Abstract
Stroke is one of the most common medical emergencies and the leading cause of preventable death and long-term disability worldwide. A prospective cohort study was conducted at the stroke unit of Jimma university medical center for four consecutive months (from March 10 to July 10, 2017). Of the total 116 study patients, 60 (51.7%) had an ischemic stroke. At 30-day follow-up, 81 (69.8%) patients were alive, 34 (29.3%) were died, and one patient (0.9%) was lost to follow-up. Elevated alanine aminotransferase (ALT) level (AHR: 3.77, 95% CI: 1.34-10.57), diagnosis of stroke clinically alone (AHR: 3.90, 95 CI: 1.49-10.26), brain edema (AHR: 4.28, 95% CI: 1.61-11.37), and National Institute of Health Stroke Scale (NIHSS) ≥ 13 during hospital arrival (AHR: 6.49, 95% CI: 1.90-22.22) were the independent predictors of 30-day mortality. At 60-day follow-up, 68 (58.6%) patients were alive, 46 (39.7%) were died, and 2 (1.7%) were lost to follow-up. Discharge against medical advice (AHR: 6.40, 95% CI: 2.31-17.73) and severe modified Rankin score/mRS (4-5) at discharge (AHR: 3.64, 95% CI: 1.01-13.16) were the independent predictors of 60-day mortality. The median (IQR) length of survival after hospital admission for patients died within 30 and 60 days were 4.65 (2.34-11.80) and 9.3 (3.93-33) days, respectively. Stroke significantly affects the morbidity and mortality in Ethiopia. There is a need to provide better care and future planning for stroke patients as an emergency diagnosis and treatment to minimize mortality and disability.
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Affiliation(s)
- Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Legese Chelkeba
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene
- School of Medicine, Institute of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Ayantu Kebede
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
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Post-stroke Complications and Mortality in Burkinabè Hospitals: Relationships with Deglutition Disorders and Nutritional Status. Dysphagia 2020; 36:85-95. [PMID: 32303906 DOI: 10.1007/s00455-020-10111-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/01/2020] [Indexed: 12/20/2022]
Abstract
Stroke frequently causes deglutition disorders, leading to a decline in nutritional status and complications, and increasing mortality. Sub-Saharan data are scarce. The objectives of this study were to assess complications and mortality among hospitalized patients in Burkina Faso during the first two weeks after stroke, and to investigate associated factors. Patients with stroke were followed prospectively in Ouagadougou and Bobo-Dioulasso hospitals. Deglutition disorders and nutritional parameters were assessed at baseline (D0) and on Days 8 (D8) and 14 (D14). Complications and mortality were recorded up to D14. Factors associated with complications and mortality were investigated using multivariate analysis. Of the 222 patients included, 81.5% developed at least one complication, and mortality was 17.1%. At D0, D8, and D14, the rate of deglutition disorders was 37.4%, 28.4%, and 15.8%, respectively, and that of undernourishment 25.2%, 29.4%, and 31.0%, respectively. In multivariate analysis, only the presence of deglutition disorders was a risk factor for developing at least one complication (OR = 5.47, 95% CI 1.81-16.51). Factors predicting death were the presence of deglutition disorders at D0 (OR = 7.19, 95% CI 3.10-16.66), and at least one seizure during follow-up (OR = 3.69, 95% CI 1.63-8.36). After stroke, the rates of complications, death, and undernourishment were high compared to Western countries. Prevention and management of deglutition disorders, and specific follow-up of patients with seizures could reduce post-stroke mortality.
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Sodium content of bread from bakeries in Maputo, Mozambique: trends between 2012 and 2018. Public Health Nutr 2020; 23:1098-1102. [DOI: 10.1017/s1368980019003951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To assess the Na content and price of bread available in bakeries in the city of Maputo in 2018 and describe trends since 2012.Design:Cross-sectional evaluation of bread sold in twenty bakeries in the city of Maputo. Three loaves of white and three loaves of brown bread were collected from each bakery when available, and Na contents were quantified by flame photometry. To assess trends, samples of white bread collected in 2012 and analysed using the same methodology were compared with samples of white bread collected in 2018 from the same bakeries.Setting:City of Maputo, capital of Mozambique.Results:In 2018, the mean (range) Na content in mg/100 g of white and brown breads were 419·1 (325·4–538·8) and 389·8 (248·0–609·0), respectively. Non-compliance with Na targets in bread according to the South African regulation (<380 mg/100 g) was observed in 70 % of white and 43 % of brown bread samples. A total of twelve bakeries had samples evaluated in both 2012 and 2018; among these, the mean Na content in white bread decreased by just over 10 % – the mean difference (95 % CI) was 46·6 mg/100 g (1·7, 91·5); and there was a significant increase of 3·7–5·4 meticais in the mean price per 100 g of white bread.Conclusions:The Na content of bread available in bakeries in the city of Maputo decreased in recent years despite the absence of a specific regulation in Mozambique.
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Bay N, Juga E, Macuacua C, João J, Costa M, Stewart S, Mocumbi A. Assessment of care provision for hypertension at the emergency Department of an Urban Hospital in Mozambique. BMC Health Serv Res 2019; 19:975. [PMID: 31852481 PMCID: PMC6921411 DOI: 10.1186/s12913-019-4820-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/09/2019] [Indexed: 12/19/2022] Open
Abstract
Background Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). Methods During a pragmatic and prospective 30-day snapshot study (with 24 h surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral de Mavalane, Maputo, we assessed patient’s flow and care, as well as health facility’s infrastructure and resources through direct observation. Reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. Results The 1911 hypertensive patients included in the study had several stops during their journey inside the health facility and followed a non-standardized care flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Conclusions Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.
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Affiliation(s)
- Neusa Bay
- Mozambique Institute for Health Education and Research, Cidade de Maputo, Mozambique
| | - Edna Juga
- Instituto Nacional de Saúde, Vila de Marracuene, Estrada Nacional N°1, Parcela N°3943, Província de Maputo, Mozambique
| | | | - José João
- Hospital Geral de Mavalane, Cidade de Maputo, Mozambique
| | - Maria Costa
- Hospital Geral de Mavalane, Cidade de Maputo, Mozambique
| | - Simon Stewart
- Torrens University, Adelaide, Australia.,Universidade Eduardo Mondlane, Cidade de Maputo, Mozambique
| | - Ana Mocumbi
- Instituto Nacional de Saúde, Vila de Marracuene, Estrada Nacional N°1, Parcela N°3943, Província de Maputo, Mozambique. .,Universidade Eduardo Mondlane, Cidade de Maputo, Mozambique.
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Manafe N, Matimbe RN, Daniel J, Lecour S, Sliwa K, Mocumbi AO. Hypertension in a resource-limited setting: Poor Outcomes on Short-term Follow-up in an Urban Hospital in Maputo, Mozambique. J Clin Hypertens (Greenwich) 2019; 21:1831-1840. [PMID: 31769184 PMCID: PMC8030297 DOI: 10.1111/jch.13732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Abstract
Mozambique has low levels of detection, treatment, and control of hypertension. However, data on target organ damage and clinical outcomes are lacking. The authors aimed at characterizing the clinical profile, pattern of target organ damage, and short-term outcomes of patients referred to a first referral urban hospital in a low-income setting in Africa. We conducted a prospective descriptive cohort study from February 2016 to May 2017 in Maputo, Mozambique. Adult patients with systolic and diastolic blood pressure ≥180 mm Hg and/or ≥110 mm Hg, respectively, or any systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg in the presence of target organ damage (with or without antihypertensive treatment) were submitted to detailed physical examination, funduscopy, laboratory profile, electrocardiography, and echocardiography. Six months after the occurrence of complications (stroke, heart failure, and renal failure), hospital admission and death were assessed. Overall, 116 hypertensive patients were recruited (mean age 57.5 ± 12.8 years old; 111[95.7%] black; 81[70%] female) of which 79 had severe hypertension. The baseline mean values recorded for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2 mm Hg, respectively. Most patients (93; 80.2%) were on antihypertensive treatment. Patients' risk profile revealed dyslipidemia, obesity, and diabetes in 59(54.1%), 48(42.5%), and 23(19.8%), respectively. Target organ damage was found in 111 patients. The commonest being left atrial enlargement 91(84.5%), left ventricular hypertrophy 57(50.4%), hypertensive retinopathy 30(26.3%), and chronic kidney disease 27(23.3%). Major events during 6-month follow-up were hospitalizations in 10.3% and death in 8.6% of the patients. Worsening of target organ damage occurred in 10 patients: four stroke, two heart failure, and four renal damage. Patients with severe hypertension and target organ damage were young with high-risk profile, low hypertension control, and high occurrence of complications during short-term follow-up. Efforts to improve high blood pressure control are needed to reduce premature mortality in this highly endemic poor setting.
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Affiliation(s)
- Naisa Manafe
- Instituto Nacional de SaudeMaputoMozambique
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | | | | - Sandrine Lecour
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Karen Sliwa
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Ana Olga Mocumbi
- Instituto Nacional de SaudeMaputoMozambique
- Universidade Eduardo MondlaneMaputoMozambique
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Chimatiro GL, Rhoda AJ. Scoping review of acute stroke care management and rehabilitation in low and middle-income countries. BMC Health Serv Res 2019; 19:789. [PMID: 31684935 PMCID: PMC6829977 DOI: 10.1186/s12913-019-4654-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 10/17/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Stroke is a major public health concern, affecting millions of people worldwide. Care of the condition however, remain inconsistent in developing countries. The purpose of this scoping review was to document evidence of stroke care and service delivery in low and middle-income countries to better inform development of a context-fit stroke model of care. METHODS An interpretative scoping literature review based on Arksey and O'Malley's five-stage-process was executed. The following databases searched for literature published between 2010 and 2017; Cochrane Library, Credo Reference, Health Source: Nursing/Academic Edition, Science Direct, BioMed Central, Cumulative Index to Nursing and Allied Health Literature (CINNAHL), Academic Search Complete, and Google Scholar. Single combined search terms included acute stroke, stroke care, stroke rehabilitation, developing countries, low and middle-income countries. RESULTS A total of 177 references were identified. Twenty of them, published between 2010 and 2017, were included in the review. Applying the Donebedian Model of quality of care, seven dimensions of stroke-care structure, six dimensions of stroke care processes, and six dimensions of stroke care outcomes were identified. Structure of stroke care included availability of a stroke unit, an accident and emergency department, a multidisciplinary team, stroke specialists, neuroimaging, medication, and health care policies. Stroke care processes that emerged were assessment and diagnosis, referrals, intravenous thrombolysis, rehabilitation, and primary and secondary prevention strategies. Stroke-care outcomes included quality of stroke-care practice, functional independence level, length of stay, mortality, living at home, and institutionalization. CONCLUSIONS There is lack of uniformity in the way stroke care is advanced in low and middle-income countries. This is reflected in the unsatisfactory stroke care structure, processes, and outcomes. There is a need for stroke care settings to adopt quality improvement strategies. Health ministry and governments need to decisively face stroke burden by setting policies that advance improved care of patients with stroke. Stroke Units and Recombinant Tissue Plasminogen Activator (rtPA) administration could be considered as both a structural and process necessity towards improvement of outcomes of patients with stroke in the LMICs.
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Affiliation(s)
- George Lameck Chimatiro
- University of the Western Cape, Cape Town, South Africa
- Medical Rehabilitation College, Box 256, Blantyre, Malawi
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Cisse FA, Damien C, Haba M, Touré ML, Barry M, Djibo ABA, Bah AK, Soumah FM, Naeije G. Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital stroke registry. Int J Stroke 2019; 15:666-667. [DOI: 10.1177/1747493019884521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.
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Affiliation(s)
- F Abass Cisse
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - C Damien
- Department of Neurology, Université Libre de Bruxelles, Bruxelles Belgium
| | - M Haba
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - ML Touré
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - M Barry
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - ABA Djibo
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - AK Bah
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - FM Soumah
- Department of Neurology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - G Naeije
- Department of Neurology, Université Libre de Bruxelles, Bruxelles Belgium
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Burden, clinical outcomes and predictors of time to in hospital mortality among adult patients admitted to stroke unit of Jimma university medical center: a prospective cohort study. BMC Neurol 2019; 19:213. [PMID: 31470811 PMCID: PMC6716869 DOI: 10.1186/s12883-019-1439-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/21/2019] [Indexed: 12/19/2022] Open
Abstract
Background The global burden of stroke epidemiology is changing rapidly. Over the 1990–2013 periods, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of stroke varies in Ethiopia between regions and over time. Hence, this study was aimed to assess the burden, clinical outcomes and predictors of time to in hospital mortality among stroke patients. Methods A prospective cohort study was carried at stroke unit of Jimma University Medical Center (JUMC) from March 10–July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictor variable with P < 0.05 was considered statistically significant. Results A total of 116 eligible stroke patients were followed over 4 months. The mean age of patients was 55.1 + 14.0 years and males comprised of 73 (62.9%). Stroke accounted for 16.5% of total medical admissions. Among the 116 patients with stroke, 91 (78.4%) were discharged alive making in hospital mortality rate of 25 (21.6%). The median time of in hospital mortality and length of hospital stay after admission of the patients were 4.38 days and 9.21 days, respectively. The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure in 17 (68.0%) followed by respiratory failure secondary to aspiration pneumonia in 11 (44.0%) patients. Brain edema (AHR: 6.27, 95% CI: 2.50–15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48–8.17), National Institute of Health Stroke Scale (NIHSS) > 13 during hospital arrival (AHR: 22.58, 95% CI: 2.95–172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96–12.54) were the independent predictors of time to in hospital mortality. Conclusions The mortality rate of stroke in this setup was comparable with other low- and middle-income countries (LMICs). There is an urgent need to establish well equipped and staffed stroke units in the country in addition to strengthening the already existing one’s. Furthermore, future work must be designed to identify the barriers to improve stroke outcomes and recovery. Electronic supplementary material The online version of this article (10.1186/s12883-019-1439-7) contains supplementary material, which is available to authorized users.
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Mocumbi AO, Cebola B, Muloliwa A, Sebastião F, Sitefane SJ, Manafe N, Dobe I, Lumbandali N, Keates A, Stickland N, Chan YK, Stewart S. Differential patterns of disease and injury in Mozambique: New perspectives from a pragmatic, multicenter, surveillance study of 7809 emergency presentations. PLoS One 2019; 14:e0219273. [PMID: 31291292 PMCID: PMC6619685 DOI: 10.1371/journal.pone.0219273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/19/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a paucity of primary data to understand the overall pattern of disease and injuries as well as related health-service utilization in resource-poor countries in Africa. OBJECTIVE To generate reliable and robust data describing the pattern of emergency presentations attributable to communicable disease (CD), non-communicable disease (NCD) and injuries in three different regions of Mozambique. METHODS We undertook a pragmatic, prospective, multicentre surveillance study of individuals (all ages) presenting to the emergency departments of three hospitals in Southern (Maputo), Central (Beira) and Northern (Nampula) Mozambique. During 24-hour surveillance in the seasonally distinct months of April and October 2016/2017, we recorded data on 7,809 participants randomly selected from 39,124 emergency presentations to the three participating hospitals. Applying a pragmatic surveillance protocol, data were prospectively collected on the demography, clinical history, medical profile and treatment of study participants. FINDINGS A total of 4,021 males and 3,788 (48.5%) females comprising 630 infants (8.1%), 2,070 children (26.5%), 1,009 adolescents (12.9%) and, 4,100 adults (52.5%) were studied. CD was the most common presentation (3,914 cases/50.1%) followed by NCD (1,963/25.1%) and injuries (1,932/24.7%). On an adjusted basis, CD was more prevalent in younger individuals (17.9±17.7 versus 26.6±19.2 years;p<0.001), females (51.7% versus 48.7%-OR 1.137, 95%CI 1.036-1.247;p = 0.007), the capital city of Maputo (59.6%) versus the more remote cities of Beira (42.8%-OR 0.532, 95%CI 0.476-0.594) and Nampula (45.8%-OR 0.538, 95%CI 0.480-0.603) and, during April (51.1% versus 49.3% for October-OR 1.142, 95%CI 1.041-1.253;p = 0.005). Conversely, NCD was progressively more prevalent in older individuals, females and in the regional city of Beira, whilst injuries were more prevalent in males (particularly adolescent/young men) and the northern city of Nampula. On a 24-hour basis, presentation patterns were unique to each hospital. INTERPRETATION Applying highly pragmatic surveillance methods suited to the low-resource setting of Mozambique, these unique data provide critical insights into the differential pattern of CD, NCD and injury. Consequently, they highlight specific health priorities across different regions and seasons in Southern Africa.
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Affiliation(s)
- Ana O. Mocumbi
- Instituto Nacional de Saúde, Maputo, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | | | | | | | | | - Igor Dobe
- Instituto Nacional de Saúde, Maputo, Mozambique
| | | | - Ashley Keates
- Australian Catholic University, Melbourne, Australia
| | | | - Yih-Kai Chan
- Australian Catholic University, Melbourne, Australia
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Abstract
OBJECTIVE To assess the current prevalence, awareness, treatment and control of arterial hypertension in Mozambican population, including adolescents and young adults, and to appraise their trends over the past decade, for the 25-64 years old population. METHODS A cross-sectional study of a representative sample of the population aged 15-64 years (n = 2965) was conducted in 2014-2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Data from a survey conducted in 2005 using the same methodological approach was used to assess trends in the age group of 25-64 years. RESULTS The prevalence of hypertension increased significantly, from 33.1 to 38.9% (P = 0.048), whereas awareness (2005 vs. 2014-2015: 14.8 vs. 14.5%, P = 0.914) and treatment among the aware (2005 vs. 2014-2015: 51.9 vs. 50.1%, P = 0.770) remained similar. Control among the treated increased (from 39.9 to 44.5%, P = 0.587), although not significantly. Mean blood pressure values increased (SBP: from 132.1 to 134.6 mmHg, P = 0.089; DBP: from 78.2 to 82.5 mmHg, P < 0.001). Among participants aged 15-24 years, in 2014-2015 the prevalence of hypertension was 13.1% (95% confidence interval: 9.8-16.4). CONCLUSION Our findings show that the prevalence of hypertension in Mozambique is among the highest in developing countries, both in adults and adolescents, portraying an ample margin for reduction of the morbidity and mortality burden because of high blood pressure.
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Jessen N, Govo V, Calua E, Machava M, Fabula A, Novela C, Mbanze I, Muianga C, Banze R, Zandamela I, Oliveira A, Xia X, Beaney T, Poulter NR, Damasceno A. Blood pressure screening in Mozambique: the May Measurement Month 2017 project-Sub-Saharan Africa. Eur Heart J Suppl 2019; 21:D80-D82. [PMID: 31043886 PMCID: PMC6479432 DOI: 10.1093/eurheartj/suz062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. In Mozambique, two national surveys of risk factors for chronic diseases were done, using the WHO STEPWISE approach, the first in 2005 and the last in 2014/2015. In this period of 10 years, the prevalence of hypertension in the adult population increased from 33.1% to 38.9% and the extremely low levels of awareness, treatment, and control did not change significantly. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Screening was conducted by volunteers, mainly in work places, markets, and religious activities, in the capital city, in most of the provincial capitals and some rural districts. About 4454 individuals were screened with a mean age of 39 years, and, after multiple imputation, 1371 (31.1%) had hypertension. Of individuals not receiving anti-hypertensive medication, 1099 (26.6%) were hypertensive. Of individuals receiving antihypertensive medication, 166 (61.6%) had uncontrolled BP. MMM17 was the largest BP screening campaign undertaken in Mozambique. These results suggest that opportunistic screening is an important tool to identify significant numbers of patients with raised BP.
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Affiliation(s)
- Neusa Jessen
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Valério Govo
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
| | - Eleutério Calua
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Moséstia Machava
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
| | - Alima Fabula
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
| | - Célia Novela
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
| | - Irina Mbanze
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Catarina Muianga
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Reginaldo Banze
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Imphikaxane Zandamela
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Angelo Oliveira
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique.,Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
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Sanuade OA, Dodoo FNA, Koram K, de-Graft Aikins A. Prevalence and correlates of stroke among older adults in Ghana: Evidence from the Study on Global AGEing and adult health (SAGE). PLoS One 2019; 14:e0212623. [PMID: 30865654 PMCID: PMC6415815 DOI: 10.1371/journal.pone.0212623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/06/2019] [Indexed: 01/19/2023] Open
Abstract
This study examines the prevalence and correlates of stroke among older adults in Ghana. This cross-sectional study retrieved data from Wave 1 of the World Health Organization (WHO) Survey on Global Ageing and Adult Health (SAGE) conducted between 2007 and 2008. The sample, comprising 4,279 respondents aged 50 years and above, was analysed using descriptive statistics, cross tabulations and Chi-Square tests, and a multivariable binary logistic regression. Respondents ranged in age from 50 to 114 years, with a median age of 62 years. Stroke prevalence was 2.6%, with the correlates being marital status, level of education, employment status, and living with hypertension or diabetes. The results showed that being separated/divorced, having primary and secondary education, being unemployed and living with hypertension and diabetes, significantly increased the odds of stroke prevalence in this population. The results suggest that interventions to reduce stroke prevalence and impact must be developed alongside interventions for hypertension, diabetes and sociodemographic/economic factors such as marital status, level of education, and employment status.
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Affiliation(s)
| | | | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana., Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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Mocumbi AO, Langa DC, Chicumbe S, Schumacher AE, Al-Delaimy WK. Incorporating selected non-communicable diseases into facility-based surveillance systems from a resource-limited setting in Africa. BMC Public Health 2019; 19:147. [PMID: 30717732 PMCID: PMC6360799 DOI: 10.1186/s12889-019-6473-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background As Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include NCD. The objectives of our study were to i) upgrade of the current surveillance system by adapting the data collection tools to NCD; ii) describe the occurrence and profile of selected NCD using these data collection tools. Methods Workshops were implemented in a first referral urban hospital of Mozambique to train clinical staff, administrative workers and nurses on NCD surveillance, as well as select conditions to be prioritized. Based on the WHO Global Action Plan and Brazaville Declaration for NCD prevention and control, we selected arterial hypertension, diabetes, stroke, chronic respiratory diseases, mental illness and cancers. Data collection tools used for CD were changed to include age, gender, outcome and visit type. Between February/2014 and January/2015 we collected data at an urban hospital in Mozambique’s capital. Results Over 12 months 92,018 new patients were assisted in this hospital. Data was missing or diagnosis was unreadable in 2637 (2.9%) thus only 89,381 were used for analysis; of these 6423 (median age 27 years; 58.4% female) had at least one selected NCD as their primary diagnosis: arterial hypertension (2397;37.31%), mental illness (1497;23.30%), asthma (1495;23.28%), diabetes (628;9.78%), stroke (299;4.66%), chronic obstructive pulmonary disease 61 (0.95%) and cancers 46 (0.72%). Emergency transfers were needed for 76 patients (1.2%), mainly due to hypertensive emergencies (31; 40.8%) and stroke (18;23.7%). Twenty-four patients died at entry points (0.3%); 10 of them had hypertensive emergencies. Conclusion Changes in existing surveillance tools for communicable diseases provided important data on the burden and outcomes of the selected NCD helping to identify priority areas for training and health care improvement. This information can be used to design the local NCD clinics and to strengthen the health information system in resource-limited settings in a progressive and sustainable way. Electronic supplementary material The online version of this article (10.1186/s12889-019-6473-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A O Mocumbi
- Instituto Nacional de Saúde, 1008 Av. Eduardo Mondlane, Maputo, Moçambique. .,Universidade Eduardo Mondlane, Maputo, Moçambique. .,Hospital Geral de Mavalane, Maputo, Moçambique.
| | - D C Langa
- Instituto Nacional de Saúde, 1008 Av. Eduardo Mondlane, Maputo, Moçambique.,Hospital Geral de Mavalane, Maputo, Moçambique
| | - S Chicumbe
- Instituto Nacional de Saúde, 1008 Av. Eduardo Mondlane, Maputo, Moçambique
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Cardiovascular Disease Healthcare Utilization in Sub-Saharan Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030419. [PMID: 30717120 PMCID: PMC6388380 DOI: 10.3390/ijerph16030419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/11/2019] [Accepted: 01/26/2019] [Indexed: 01/03/2023]
Abstract
Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008⁻2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.
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Namale G, Kamacooko O, Kinengyere A, Yperzeele L, Cras P, Ddumba E, Seeley J, Newton R. Risk Factors for Hemorrhagic and Ischemic Stroke in Sub-Saharan Africa. J Trop Med 2018; 2018:4650851. [PMID: 29955233 PMCID: PMC6000918 DOI: 10.1155/2018/4650851] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/23/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In sub-Saharan Africa (SSA), there is a significant burden of ischemic stroke (IS) and hemorrhagic stroke (HS), although data on risk factors for each type are sparse. In this systematic review we attempt to characterize the risk factors. METHODS We systematically reviewed (PubMed, EMBASE, WHOLIS, Google Scholar, Wiley online, and the Cochrane Central Register of Controlled Trials (CENTRAL)) case-control studies and case series from 1980 to 2016 that reported risk factors for IS and/or HS in SSA. For each risk factor we calculated random-effects pooled odds ratios (ORs) for case-control studies and pooled prevalence estimates for case series. Results. We identified 12 studies, including 4,387 stroke patients. Pooled analysis showed that patients who had diabetes (OR = 2.39; 95% CI: 1.14-5.03) and HIV (OR = 2.46 (95% CI: 1.59-3.81) were at a significantly greater risk of suffering from all stroke types. There were insufficient data to examine these factors by stroke type. Among case series, the pooled prevalence of hypertension was higher for HS than for IS (73.5% versus 62.8%), while diabetes mellitus (DM) and atrial fibrillation (AF) were more prevalent among IS compared to HS (15.9% versus 10.6% and 9.6% versus 2.3%, respectively). CONCLUSIONS There remain too few data from SSA to reliably estimate the effect of various factors on the risk of IS and HS. Furthermore, the vast majority of cases were identified in hospital and so are unlikely to be representative of the totality of stroke cases in the community.
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Affiliation(s)
| | | | - Alison Kinengyere
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Patrick Cras
- University of Antwerp, Department of Neurology, Antwerp, Belgium
| | - Edward Ddumba
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- University of York, UK
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Diendéré J, Millogo A, Preux PM, Jésus P, Desport JC. Changes in nutritional state and dysphagia in stroke patients monitored during a 14-d period in a Burkina Faso hospital setting. Nutrition 2017; 48:55-60. [PMID: 29469020 DOI: 10.1016/j.nut.2017.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/13/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Dysphagia and undernourishment are common in cerebrovascular accident (stroke) patients in developed countries. Despite the dietary transition, there is little information available in Africa on this topic. This study aims to assess the prevalence of undernourishment and dysphagia in stroke patients in two Burkina Faso teaching hospitals at a starting point (D0), on the eighth day, and on the 14th (D14) and to specify factors related to undernourishment at day 14. METHODOLOGY The nutritional state of the patients was assessed using body mass index, triceps skinfold thickness, and mid-upper arm circumference. Dysphagia was identified using the Practical Aspiration Screening Schema. RESULTS A total of 222 patients were included in the study. From D0 to D14, the prevalence of undernourishment increased from 25.2% to 31.0% and the prevalence of dysphagia decreased from 37.4% to 15.8%. All nutritional criteria worsened. In a multivariate analysis, undernourishment was more present at D14 for women (odds ratio [OR] = 7.01; 95% confidence interval [CI]: 1.51-32.56, P = 0.01) and was less present if weight (OR = 0.69; 95% CI: 0.60-0.79, P = 0.0001) or triceps skinfold thickness (OR = 0.85; 95% CI: 0.74-0.99, P = 0.03) were high at D0. CONCLUSION The prevalence of undernourishment was high at D0 and increased during the monitoring period. It would be advisable to monitor patients' weight and triceps skinfold thickness, to optimize care for women and patients with low weight or triceps skinfold thickness at D0, to monitor dysphagia, and to inform patients, families, and relevant staff of nutritional concerns after a cerebrovascular accident.
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Affiliation(s)
- Jeoffray Diendéré
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France; Research Institute of Health Sciences/Centre MURAZ, Bobo-Dioulasso, Burkina Faso; Université Ouaga I Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Athanase Millogo
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France; Université Ouaga I Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Medicine Department, Souro Sanou University Hospital, Bobo-Dioulasso, Burkina Faso
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France
| | - Pierre Jésus
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France; Nutrition Unit and Specialized Centre for Obesity, Dupuytren University Hospital, Limoges, France
| | - Jean-Claude Desport
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, University of Limoges, UMR_S 1094, Limoges, France; Nutrition Unit and Specialized Centre for Obesity, Dupuytren University Hospital, Limoges, France.
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Queiroz A, Damasceno A, Jessen N, Novela C, Moreira P, Lunet N, Padrão P. Urinary Sodium and Potassium Excretion and Dietary Sources of Sodium in Maputo, Mozambique. Nutrients 2017; 9:nu9080830. [PMID: 28771193 PMCID: PMC5579623 DOI: 10.3390/nu9080830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022] Open
Abstract
This study aimed to evaluate the urinary excretion of sodium and potassium, and to estimate the main food sources of sodium in Maputo dwellers. A cross-sectional evaluation of a sample of 100 hospital workers was conducted between October 2012 and May 2013. Sodium and potassium urinary excretion was assessed in a 24-h urine sample; creatinine excretion was used to exclude unlikely urine values. Food intake in the same period of urine collection was assessed using a 24-h dietary recall. The Food Processor Plus® was used to estimate sodium intake corresponding to naturally occurring sodium and sodium added to processed foods (non-discretionary sodium). Salt added during culinary preparations (discretionary sodium) was computed as the difference between urinary sodium excretion and non-discretionary sodium. The mean (standard deviation) urinary sodium excretion was 4220 (1830) mg/day, and 92% of the participants were above the World Health Organization (WHO) recommendations. Discretionary sodium contributed 60.1% of total dietary sodium intake, followed by sodium from processed foods (29.0%) and naturally occurring sodium (10.9%). The mean (standard deviation) urinary potassium excretion was 1909 (778) mg/day, and 96% of the participants were below the WHO potassium intake recommendation. The mean (standard deviation) sodium to potassium molar ratio was 4.2 (2.4). Interventions to decrease sodium and increase potassium intake are needed in Mozambique.
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Affiliation(s)
- Ana Queiroz
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.
| | - Albertino Damasceno
- Faculdade de Medicina da Universidade Eduardo Mondlane, Avenida Salvador Allende, n° 702, 1111 Maputo, Mozambique.
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Neusa Jessen
- Faculdade de Medicina da Universidade Eduardo Mondlane, Avenida Salvador Allende, n° 702, 1111 Maputo, Mozambique.
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal.
| | - Célia Novela
- Faculdade de Medicina da Universidade Eduardo Mondlane, Avenida Salvador Allende, n° 702, 1111 Maputo, Mozambique.
| | - Pedro Moreira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal.
- Centro de Investigação em Atividade Física, Saúde e Lazer, Universidade do Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal.
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal.
| | - Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal.
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Stroke characterization in Sun Saharan Africa: Congolese population. Int J Cardiol 2017; 240:392-397. [DOI: 10.1016/j.ijcard.2017.04.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/26/2017] [Accepted: 04/19/2017] [Indexed: 11/15/2022]
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Stenumgård PS, Rakotondranaivo MJ, Sletvold O, Follestad T, Ellekjær H. Stroke in a resource-constrained hospital in Madagascar. BMC Res Notes 2017; 10:307. [PMID: 28738901 PMCID: PMC5525216 DOI: 10.1186/s13104-017-2627-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/13/2017] [Indexed: 11/11/2022] Open
Abstract
Background Stroke is reported as the most frequent cause of in-hospital death in Madagascar. However, no descriptive data on hospitalized stroke patients in the country have been published. In the present study, we sought to investigate the feasibility of collecting data on stroke patients in a resource-constrained hospital in Madagascar. We also aimed to characterize patients hospitalized with stroke. Methods We registered socio-demographics, clinical characteristics, and early outcomes of patients admitted for stroke between 23 September 2014 and 3 December 2014. We used several validated scales for the evaluation. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS), disability by the modified Rankin Scale (mRS), and function by the Barthel Index (BI). Results We studied 30 patients. Sixteen were males. The median age was 62.5 years (IQR 58–67). The NIHSS and mRS were completed for all of the patients, and BI was used for the survivors. Three patients received a computed tomography (CT) brain scan. The access to laboratory investigations was limited. Electrocardiographs (ECGs) were not performed. The median NIHSS score was 16.5 (IQR 10–35). The in-hospital stroke mortality was 30%. At discharge, the median mRS score was 5 (IQR 4–6), and the median BI score was 45 (IQR 0–72.5). Conclusions Although the access to brain imaging and supporting investigations was deficient, this small-scale study suggests that it is feasible to collect essential data on stroke patients in a resource-constrained hospital in Madagascar. Such data should be useful for improving stroke services and planning further research. The hospitalized stroke patients had severe symptoms. The in-hospital stroke mortality was high. At discharge, the disability category was high, and functional status low.
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Affiliation(s)
- Pål Sigurd Stenumgård
- Department of Geriatrics, St. Olavs Hospital, Postbox 3250, Sluppen, 7006, Trondheim, Norway. .,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.
| | | | - Olav Sletvold
- Department of Geriatrics, St. Olavs Hospital, Postbox 3250, Sluppen, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postbox 8905, 7491, Trondheim, Norway.,Stroke Unit, St. Olavs Hospital, Postbox 3250, Sluppen, 7006, Trondheim, Norway
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Keates AK, Mocumbi AO, Ntsekhe M, Sliwa K, Stewart S. Cardiovascular disease in Africa: epidemiological profile and challenges. Nat Rev Cardiol 2017; 14:273-293. [PMID: 28230175 DOI: 10.1038/nrcardio.2017.19] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease (CVD). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated. The success of any strategies designed to reduce the evolving and increasing burden of CVD across the heterogeneous communities living on the African continent will be dependent upon accurate and up-to-date epidemiological data on the cardiovascular profile of every major populace and region. In this Review, we provide a contemporary picture of the epidemiology of CVD in Africa, highlight key regional discrepancies among populations, and emphasize what is currently known and, more importantly, what is still unknown about the CVD burden among the >1 billion people living on the continent.
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Affiliation(s)
- Ashley K Keates
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
| | - Ana O Mocumbi
- Instituto Nacional de Saúde, Ministério da Saúde, Av. Eduardo Mondlane/Salvador Allende Caixa Postal 264, Maputo, Moçambique
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Old Main Building, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
| | - Karen Sliwa
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Centre, 4th floor Chris Barnard Building, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Centre, 4th floor Chris Barnard Building, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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Ahanogbe KMH, Belo M, Beketi AK, Kpelao S, Doleagbenou KA. [Problematics of subarachnoid hemorrhage in developing countries: The case of Togo]. Neurochirurgie 2016; 62:312-316. [PMID: 27817852 DOI: 10.1016/j.neuchi.2016.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 04/11/2016] [Accepted: 06/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the diagnostic and therapeutic strategies as well as the results of the treatment of spontaneous subarachnoid hemorrhage (SAH) in Togo, before creating a neurosurgery department. METHODS We conducted a case series of subarachnoid hemorrhage collected from 30 June 2005 to 30 June 2010 in the Universities Hospital of Lomé. It involved patients older than 15 years of age hospitalized for subarachnoid hemorrhage with clinical and/or radiation confirmation. RESULTS Thirty-five cases of SAH were found and corresponded to 0.20 % of neurological emergencies. The average age was 48 years with a range of 22 to 78 years with a sex-ratio F/H 1.33. The consciousness disorders (48.57 %) and headaches (42.85 %) were the main reasons for admission. Seventeen patients (48.57 %) had hypertension and 14 (40 %) were ethylic. Lumbar puncture performed in 9 patients (25.71 %) and CT scan in 29 patients (82.86 %), respectively, had a sensitivity of 100 % and 93.10 %. Four cases of intracranial aneurysm were diagnosed. The admission average was 3.07±3.69 days. The treatment was mainly symptomatic. Mortality was 22.85 % and severe disability was observed in 8 patients (22.85 %). CONCLUSION The profile of the SAH in Lomé appeared to differ from the literature. Too low a proportion of aneurysm is diagnosed. The equipment of Hospital and neurosurgeons training would be needed to improve the management of this pathology.
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Affiliation(s)
- K M H Ahanogbe
- Service de neurochirurgie, CHU Sylvanus Olympio, Lomé, Togo.
| | - M Belo
- Service de neurologie, CHU Sylvanus Olympio, Lomé, Togo
| | - A K Beketi
- Service de neurochirurgie, CHU Sylvanus Olympio, Lomé, Togo
| | - S Kpelao
- Service de neurochirurgie, CHU Sylvanus Olympio, Lomé, Togo
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Goulart AC. "EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity". SAO PAULO MED J 2016; 134:543-554. [PMID: 28076632 DOI: 10.1590/1516-3180.2016.024227092016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/27/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). DESIGN AND SETTINGS: Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014. METHODS: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. RESULTS: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55). CONCLUSION: Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system.
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Affiliation(s)
- Alessandra Carvalho Goulart
- MD, PhD. Clinical Epidemiologist and Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo (SP), Brazil
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Hypertension in Sub-Saharan Africa: A Contextual View of Patterns of Disease, Best Management, and Systems Issues. Cardiol Rev 2016; 24:30-40. [PMID: 26284525 DOI: 10.1097/crd.0000000000000083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sub-Saharan Africa (SSA) bears the highest burden of both communicable and noncommunicable disease and has the weakest health systems. Much attention is directed toward a rising burden of chronic disease in the setting of epidemiologic transition and urbanization. Indeed, the highest prevalence of hypertension globally is in the World Health Organization's African region at 46% of adults aged 25 and above. And while hypertension in SSA is common, its prevalence varies significantly between urban and rural settings. Although there is evidence for epidemiologic transition in urban areas, there is also evidence of static levels of hypertension within rural areas, which comprise more than 70% of the population of SSA. Furthermore, overall cardiovascular (CV) risk in rural areas remains low. The mean age of hypertensives in SSA is approximately 30s to 40s, burdening those at peak productivity. Complications of hypertension are frequent, given the poor levels of awareness and treatment (<10%) of hypertension on the continent. Such complications include primarily stroke and hypertensive heart disease, as ischemic heart disease is uncommon. Mortality associated with these complications is high, with in-hospital mortality from 2 different sites reported as around 20%. The overall burden of hypertension is likely to be more related to poor access and availability of health systems and is representative of a looming crisis in health care delivery. The best approaches to population-wide treatment are those that utilize CV risk prediction for those with stage 1 hypertension, whereas treatment is generally indicated for all those with stage 2 or greater hypertension, especially in light of the high burden of stroke in SSA. Current guidelines recommend first-line drug therapy with a diuretic or calcium channel blocker. Despite these recommendations, the major obstacles to hypertension treatment are systemic and include the availability and cost of medications, the adequacy of health facilities and systems, and the lack of health insurance to address affordability. New and innovative systems-oriented approaches are needed to address the burden of hypertension on a platform of global equity.
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Rosendaal NTA, Hendriks ME, Verhagen MD, Bolarinwa OA, Sanya EO, Kolo PM, Adenusi P, Agbede K, van Eck D, Tan SS, Akande TM, Redekop W, Schultsz C, Gomez GB. Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program. PLoS One 2016; 11:e0157925. [PMID: 27348310 PMCID: PMC4922631 DOI: 10.1371/journal.pone.0157925] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/07/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND High blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA). We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI) program in rural Nigeria. METHODS A Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD) within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY) averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1) presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy) and 2) presence of hypertension in combination with a CVD risk of >20% (risk based strategy). We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario. RESULTS Screening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second strategy respectively ranged from US$ 1,406 to US$ 7,815 and US$ 732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment. CONCLUSIONS Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities to finance CVD prevention care in SSA.
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Affiliation(s)
- Nicole T. A. Rosendaal
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
- Office of Public Health Studies, University of Hawaii, John A. Burns School of Medicine, 1960 East-West Road, Honolulu, HI, United States of America
| | - Marleen E. Hendriks
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
| | - Mark D. Verhagen
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
| | - Oladimeji A. Bolarinwa
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
| | - Emmanuel O. Sanya
- Department of Medicine, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
| | - Philip M. Kolo
- Department of Medicine, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
| | - Peju Adenusi
- Hygeia Nigeria Ltd, 13B Idejo Street, Victoria Island, Lagos, Nigeria
| | | | | | - Siok Swan Tan
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tanimola M. Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
| | - William Redekop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Constance Schultsz
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
| | - Gabriela B. Gomez
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Owolabi MO, Akarolo-Anthony S, Akinyemi R, Arnett D, Gebregziabher M, Jenkins C, Tiwari H, Arulogun O, Akpalu A, Sarfo FS, Obiako R, Owolabi L, Sagoe K, Melikam S, Adeoye AM, Lackland D, Ovbiagele B. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovasc J Afr 2016; 26:S27-38. [PMID: 25962945 PMCID: PMC4557491 DOI: 10.5830/cvja-2015-038] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa. Methods We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures. Results Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown. Conclusions While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.
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Affiliation(s)
- Mayowa O Owolabi
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | | | - Oyedunni Arulogun
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | - Sylvia Melikam
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Abiodun M Adeoye
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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Adeleye AO, Osazuwa UA, Ogbole GI. The Clinical Epidemiology of Spontaneous ICH in a Sub-Sahara African Country in the CT Scan Era: A Neurosurgical In-Hospital Cross-Sectional Survey. Front Neurol 2015; 6:169. [PMID: 26300843 PMCID: PMC4525060 DOI: 10.3389/fneur.2015.00169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/20/2015] [Indexed: 11/24/2022] Open
Abstract
Background There is paucity of data-driven scientific reports from sub-Saharan Africa on the burden of spontaneous intracerebral hemorrhage (sICH). We have maintained a prospective consecutive in-hospital database of cases of sICH referred for neurosurgical intervention over a 5-year period. Methods This is a cross-sectional descriptive study of the clinical epidemiology and brain computed tomography (CT) characterization of sICH from the database in this region in the current era. Results There were 63 subjects, 38 (60.3%) males, aged 28–85 years, mean 55.7 (SD, 12.7), the modal age distribution being the sixth decade. Uncontrolled hypertension was the main predisposition in the study: present, premorbid, in 79%, but uncontrolled in 88% of these known cases, and exhibited malignant derangements of blood pressure in more than half. The clinical ictus to in-hospital presentation was delayed, median 72 h; was in severe clinical state in 70%, 57% was comatose; and was complicated with fever in 57% and respiratory morbidity in 55.6%. The main clinical symptomatology was hemiparesis, headache, vomiting, and aphasia. The sICH was supratentorial on brain CT in 90.5%, ganglionic in 50.8%, and thalamic in 58.3% of the latter. The bleed had CT evidence of mass effect and intraventricular extension (IVH) in more than half. Twenty-three patients (36.5%) underwent operative interventions. Conclusion In this patient population, sICH is mainly ganglionic and thalamic in location with significant rate of associated IVH. In-hospital clinical presentation is delayed, and in a critical state, the bleeding is uncontrolled hypertension related in >95%.
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Affiliation(s)
- Amos Olufemi Adeleye
- Department of Surgery, Division of Neurological Surgery, College of Medicine, University College Hospital (UCH), University of Ibadan , Ibadan , Nigeria
| | - Uyiosa A Osazuwa
- Department of Neurological Surgery, University College Hospital (UCH) , Ibadan , Nigeria
| | - Godwin I Ogbole
- Department of Radiology, College of Medicine, University College Hospital (UCH), University of Ibadan , Ibadan , Nigeria
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Gomes J, Damasceno A, Carrilho C, Lobo V, Lopes H, Madede T, Pravinrai P, Silva-Matos C, Diogo D, Azevedo A, Lunet N. Triggering of stroke by ambient temperature variation: a case-crossover study in Maputo, Mozambique. Clin Neurol Neurosurg 2014; 129:72-7. [PMID: 25559679 DOI: 10.1016/j.clineuro.2014.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The effect of ambient temperature as a stroke trigger is likely to differ by type of stroke and to depend on non-transient exposures that influence the risk of this outcome. We aimed to quantify the association between ambient temperature variation and stroke, according to clinical characteristics of the events, and other risk factors for stroke. METHODS We conducted a case-crossover study based on a 1-year registry of the hospital admissions due to newly occurring ischemic and hemorrhagic stroke events in Maputo, Mozambique's capital city (N=593). The case-period was defined as the 7 days before the stroke event, which was compared to two control periods (14-21 days and 21-28 days before the event). We computed humidity- and precipitation-adjusted odds ratios (OR) and 95% confidence intervals (95%CI) using conditional logistic regression. RESULTS An association between minimum temperature declines higher than 2.4 °C in any two consecutive days in the previous week and the occurrence of stroke was observed only for first events (OR=1.43, 95%CI: 1.15-1.76). Stronger and statistically significant associations were observed for hemorrhagic stroke (OR=1.50, 95%CI: 1.07-2.09) and among subjects not exposed to risk factors, including smoking, high serum cholesterol or atrial fibrillation. No differences in the effect of temperature were found according to the patients' vital status 28 days after the event. CONCLUSIONS First stroke events, especially of the hemorrhagic type, were triggered by declines in the minimum temperature between consecutive days of the preceding week.
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Affiliation(s)
- Joana Gomes
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health, University of Porto (ISPUP), Porto, Portugal.
| | - Albertino Damasceno
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Carrilho
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Vitória Lobo
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Hélder Lopes
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Tavares Madede
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Pius Pravinrai
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Silva-Matos
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Domingos Diogo
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ana Azevedo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health, University of Porto (ISPUP), Porto, Portugal
| | - Nuno Lunet
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Institute of Public Health, University of Porto (ISPUP), Porto, Portugal
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Thrift AG, Cadilhac DA, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Donnan GA. Global stroke statistics. Int J Stroke 2014; 9:6-18. [PMID: 24350870 DOI: 10.1111/ijs.12245] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In many countries, stroke is a lower priority than other diseases despite its public health impact. One issue is a lack of readily accessible comparative data to help make the case for the development of national stroke strategies. To assist in this process, we need to have a common repository of the latest published information on the impact of stroke worldwide. We aim to provide a repository of the most current incidence and mortality data on stroke available by country and illustrate the gaps in these data. We plan to update this repository annually and expand the scope to address other aspects of the burden of stroke. Data were compiled using two approaches: (1) an extensive literature review with a major focus on published systematic reviews on stroke incidence (between 1980 and May 14, 2013); and (2) direct acquisition and collation of data from the World Health Organization to present the most current estimates of stroke mortality for each country recognized by the World Health Organization. For mortality, ICD8, ICD9, and ICD10 mortality codes were extracted. Using population denominators crude stroke mortality was calculated, as well as adjusting for the World Health Organization world population. We used only the most recent year reported to the World Health Organization. Incidence rates for stroke were available for 52 countries, with some countries having incidence studies undertaken in more than one region. When adjusted to the World Health Organization world standard population, incidence rates for stroke ranged from 41 per 100 000 population per year in Nigeria (1971-74) to 316/ 100 000/year in urban Dar-es-Salaam (Tanzania). Some regions had three to fivefold greater incidence than other countries. Of the 123 countries reporting mortality data, crude mortality was greatest in Kazhakstan (in 2003). In many regions data were very old or nonexistent. Such country-level data are important for citizens, clinicians, and policy makers so that local and global strategies to reduce the overall burden of stroke can be implemented. Through this first annual review of country-specific stroke epidemiology, we hope to promote discussion and provide insights into the worldwide burden of stroke.
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Affiliation(s)
- Amanda G Thrift
- Department of Medicine, Stroke and Ageing Research Centre, Southern Clinical School, Monash University, Clayton, Vic., Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia
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The definition of a prolonged intensive care unit stay for spontaneous intracerebral hemorrhage patients: an application with national health insurance research database. BIOMED RESEARCH INTERNATIONAL 2014; 2014:891725. [PMID: 25126579 PMCID: PMC4122095 DOI: 10.1155/2014/891725] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/26/2022]
Abstract
Introduction. Length of stay (LOS) in the intensive care unit (ICU) of spontaneous intracerebral hemorrhage (sICH) patients is one of the most important issues. The disease severity, psychosocial factors, and institutional factors will influence the length of ICU stay. This study is used in the Taiwan National Health Insurance Research Database (NHIRD) to define the threshold of a prolonged ICU stay in sICH patients. Methods. This research collected the demographic data of sICH patients in the NHIRD from 2005 to 2009. The threshold of prolonged ICU stay was calculated using change point analysis. Results. There were 1599 sICH patients included. A prolonged ICU stay was defined as being equal to or longer than 10 days. There were 436 prolonged ICU stay cases and 1163 nonprolonged cases. Conclusion. This study showed that the threshold of a prolonged ICU stay is a good indicator of hospital utilization in ICH patients. Different hospitals have their own different care strategies that can be identified with a prolonged ICU stay. This indicator can be improved using quality control methods such as complications prevention and efficiency of ICU bed management. Patients' stay in ICUs and in hospitals will be shorter if integrated care systems are established.
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Padrão P, Severo M, Damasceno A, Silva-Matos C, Prista A, Azevedo A, Lunet N. Model-based patterns of cardiovascular risk factors in Mozambique. Ann Hum Biol 2014; 42:159-66. [PMID: 25010409 DOI: 10.3109/03014460.2014.932010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Risk factors for cardiovascular diseases tend to cluster, although evidence from settings under epidemiological transition is scarce. AIM To identify patterns of clustering of cardiovascular risk factors and to quantify their association with sociodemographic characteristics, in Mozambique. SUBJECTS AND METHODS A national representative sample (n = 3323) of subjects aged 25-64 years was evaluated in 2005, using the World Health Organization Stepwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). Patterns of joint exposure to high blood pressure, high fasting blood glucose, high body mass index, smoking, excessive alcohol consumption, low fruit/vegetables intake and insufficient physical activity were identified through latent class analysis. RESULTS Three patterns were identified among women: (1) "healthier", lower frequency of most risk factors (53.0%); (2) "hypertension-overweight" (21.1%), more frequent among older and urban subjects; and (3) "hypertension-smoking-alcohol" (25.9%), whose frequency increased with age and decreased with education. In men, two clusters were identified: (1) "hypertension-overweight" (30.1%); and (2) "smoking" (69.9%). The frequency of the latter pattern was higher in urban areas and increased with age and education. CONCLUSION Hypertension, overweight/obesity, smoking and excessive alcohol intake defined the main clusters of cardiovascular risk factors. This should be considered when planning prevention and control strategies for cardiovascular diseases in Mozambique.
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