1
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van Hoogland-van Heerden M, Böhmer LH, Heyneke O, Lechaba T, Scott L, Norton G, Woodiwiss A, Mntla P, Majane OHI. Characteristics of heart failure with a preserved ejection fraction in black South African patients. IJC HEART & VASCULATURE 2024; 52:101408. [PMID: 38638536 PMCID: PMC11024654 DOI: 10.1016/j.ijcha.2024.101408] [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: 11/27/2023] [Revised: 03/14/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
Background Heart failure with a preserved ejection fraction (HFpEF) is common in the elderly (≥75 years) and associated with arterial stiffness. The mean age of HFpEF presentation is lower (40-55 years) in sub-Saharan Africa. No clinical study has been conducted on HFpEF in identifying and characterising this phenotype at a younger age, moreover in a South African black population where the risk of HFpEF is two times higher than in other ethnic groups. This study investigated the characteristics of HFpEF in a black South African population, the biochemical markers that predict HFpEF and cardiac structural changes in this HF phenotype. Methods Sixty-six participants with HFpEF and 213 controls were enrolled. All participants gave informed consent and completed a standardised questionnaire. Echocardiographic, anthropometric, central haemodynamic measurements, pulse wave velocity (PWV) and biomarker analysis were done. Results The mean age of HFpEF participants was 54.88 ± 13.51 years. Most of the participants (76 %) were between 20 and 64 years, while only 24 % were older. HFpEF participants were hypertensive, and more obese with increased incidence of alcohol consumption. PWV was increased in HFpEF (9.97 ± 2.78 m/s) when compared to participants without HFpEF (6.11 ± 2.18 m/s), p < 0.0001. There were no significant associations between central haemodynamic parameters, N-terminal pro B-type natriuretic peptide (NT-proBNP) (p = 0.9746), and galectin-3 (p = 0.2166). NT-proBNP, but not galectin-3, was associated with left ventricular hypertrophy (p = 0.0002) and left atrial diameter (p = 0.0005). Conclusion HFpEF in South Africa is predominant in obese young to middle-age individuals with arterial stiffness and who consume alcohol regularly. NT-proBNP could be used to diagnose HFpEF, however, should be interpreted with caution in populations with a high prevalence of obesity.
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Affiliation(s)
| | - LH Böhmer
- Sefako Makgatho Health Sciences University, South Africa
| | - O Heyneke
- Sefako Makgatho Health Sciences University, South Africa
| | - T Lechaba
- Sefako Makgatho Health Sciences University, South Africa
| | - L Scott
- Sefako Makgatho Health Sciences University, South Africa
| | - G Norton
- University of the Witwatersrand, South Africa
| | - A Woodiwiss
- University of the Witwatersrand, South Africa
| | - P Mntla
- Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, South Africa
| | - OHI Majane
- Sefako Makgatho Health Sciences University, South Africa
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2
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Wiafe YA, Acheamfour-Akowuah E, Owusu IK. Indications for echocardiography and confirmation rates of cardiovascular diseases: experience of a specialist cardiac outpatient clinic in Kumasi, Ghana. Ann Afr Med 2023; 22:440-445. [PMID: 38358143 PMCID: PMC10775930 DOI: 10.4103/aam.aam_151_22] [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: 10/29/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/16/2024] Open
Abstract
Background Transthoracic echocardiography is a very helpful noninvasive cardiovascular imaging technique for the diagnosis and risk stratification in the management of patients with cardiovascular diseases. We aimed to review the clinical indications for transthoracic echocardiography and the confirmation rate of cardiovascular diseases by echocardiography at a specialist cardiac clinic in Ghana. Methods Using a cross-sectional study design, the echocardiography reports of all patients above the age of 15 who were assessed at the clinic were analyzed. Data on patient demographics, clinical history, clinical indication for echocardiography, and the echocardiographic findings were analyzed using version 25.0 of the Statistical Package for Social Sciences (SPSS). Results A total of 594 participants were studied. The age range of participants was 15-96 years, with a mean (± standard deviation) age of 53.72 (± 17.25) years. There were more females (50.17%) than males (49.83%). Most (54.21%) of the participants had echocardiography for cardiac evaluation. Other indications included hypertension/hypertensive heart disease (HHD) (n = 131; 22.06%), heart failure (n = 69; 11.62%), chest pains (n = 12; 2.02%), and valvular heart disease (VHD) (n = 11; 1.85%). Three hundred and eight-nine (70.30%) of the participants had their clinical diagnoses confirmed by echocardiography; echocardiographic confirmation rates for heart failure, VHD, and HHD were 92.75%, 90.91%, and 88.54%, respectively. Conclusion Echocardiography showed high confirmation rates for our patients with heart failure, VHD, and HHD. Prompt usage of this noninvasive cardiovascular imaging for the initial evaluation of patients with cardiovascular diseases is highly recommended.
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Affiliation(s)
- Yaw Amo Wiafe
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Acheamfour-Akowuah
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Kofi Owusu
- Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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3
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Jonathan IA, Kifai E, Chillo P. Spectrum of cardiac diseases among young and older adults defined by echocardiography at Jakaya Kikwete Cardiac Institute: A prospective cross-sectional study. BMC Cardiovasc Disord 2023; 23:359. [PMID: 37464288 PMCID: PMC10355001 DOI: 10.1186/s12872-023-03367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide, with data showing an increasing trend. Previously uncommon, CVDs of lifestyle are now increasing in many Sub-Sahara African (SSA) countries including Tanzania. The study aimed at determining the spectrum and distribution of CVDs among young (< 45 years) and older (≥ 45 years) adults referred for echocardiography at Jakaya Kikwete Cardiac Institute (JKCI). METHODS Hospital-based cross sectional study was conducted among adult patients referred for echocardiography at JKCI between July and December 2021. Patient's socio-demographic and clinical characteristics were recorded. CVD diagnoses were made using established diagnostic criterias. Comparisons were done using chi-square test and student's t-test. Multivariable logistic regression analysis was used to determine factors associated with abnormal echocardiography. A significance level was set at p-value < 0.05. RESULTS In total 1,050 patients (750 old and 300 young adults) were enrolled. The mean ± SD age was 62.2 ± 10.4 years and 33.5 ± 7.4 years for older and young adults respectively. Hypertension was the commonest indication for echocardiography both in the young (31%) and older (80%) adults. Majority of older adults were found to have abnormal echocardiography (90.7%), while only 44.7% of the young adults had abnormal echocardiography (p < 0.001). For the older adults, the commonest diagnoses were HHD (70.3%), IHD (9.7%), and non-ischemic cardiomyopathy (6.1%) while for young adults, HHD (16.7%), non-ischemic cardiomyopathy (8%), RHD (8%) and MVP (4.3%) were the commonest. The differences in the echocardiographic diagnoses between young and older adults were statistically significant, p < 0.001. Being an older adult, hypertensive, overweight/obese were independently associated with abnormal echocardiography (p < 0.01). CONCLUSION Hypertensive heart disease is the most common diagnosis among adult patients referred for echocardiography at JKCI, both in young and older adults. Primary prevention, early detection and treatment of systemic hypertension should be reinforced in order to delay or prevent its complications.
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Affiliation(s)
- Irene Abela Jonathan
- School of Medicine, Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, P.O. BOX 65001, Tanzania.
| | - Engerasiya Kifai
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania
| | - Pilly Chillo
- School of Medicine, Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, P.O. BOX 65001, Tanzania
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania
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4
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Adamu UG, Tanko M, Abdullahi A, Ndajiya U, Ibok IO. Hypertension and its complications are also common in low-resource specialty clinics. Hypertens Res 2023; 46:214-218. [PMID: 36243762 DOI: 10.1038/s41440-022-01053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023]
Abstract
The spectrum of cardiovascular diseases in an outpatient low-resource rural specialty tertiary center is not well documented. The study aimed to determine the spectrum of cardiovascular diseases in this setting. We analyzed the medical records of 748 patients with complete data between June 1 and December 31, 2017. The mean age was 49.11 ± 14.47 years. The females were younger than the males (46.21 ± 14.78 vs. 53.64 ± 13.29 p value < 0.001). Hypertensive heart disease was the most common disorder (416 cases, 55.6%). Two hundred and five patients had heart failure (49.28%), while peripartum cardiomyopathy occurred in 8.33%. Seventy-five patients had valvular heart disease, 68% due to rheumatic heart disease.
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Affiliation(s)
- Umar G Adamu
- Department of Internal Medicine, Federal Medical Center, Bida, Nigeria. .,Division of Cardiology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
| | - Musa Tanko
- Department of Internal Medicine, Federal Medical Center, Bida, Nigeria
| | - Aisha Abdullahi
- Department of Nursing Services, General Hospital, Minna, Nigeria
| | - Umar Ndajiya
- Department of Internal Medicine, Federal Medical Center, Bida, Nigeria
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5
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Alıcı G, Genç Ö. Spectrum of cardiovascular diseases at a referral tertiary care hospital in Somalia, Mogadishu: an echocardiographic study. BMC Cardiovasc Disord 2021; 21:599. [PMID: 34915844 PMCID: PMC8680378 DOI: 10.1186/s12872-021-02417-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To investigate the frequencies and patterns of cardiovascular diseases (CVDs), including rheumatic and congenital heart diseases, among patients with abnormal hearts assessed by echocardiographic examination. METHODS This retrospective, descriptive registry reviewed abnormal echocardiographic findings of 1140 patients aged 0-100 years who were admitted to the cardiology outpatient clinic at a tertiary training institution in Mogadishu. RESULTS Hypertensive heart disease (HHD) (n:454, 39.8%), valvular heart disease (VHD) (n:395, 34.6%), and heart failure with reduced ejection fraction (HFrEF) (n:351, 30.8%) were the most frequent comorbidities. Congenital heart diseases (CHDs) were detected in 151 (13.2%) of the patients, with the most common ones including atrial septal defect (ASD) (n:37, 3.2%) and ventricular septal defect (VSD) (n:26, 2.3%). Rheumatic heart disease (RHD) was observed in 84 (7.4%) patients, among whom the most common age range was 16-30 years (40.5%), followed by 31-45 years (31%) and 0-15 years (15.5%). Mitral insufficiency (n:541, 47.5%) was detected as the most frequent VHD, followed by aortic insufficiency (n:437, 38.3%), and tricuspid insufficiency (n:264, 23.2%) and mitral valve stenosis (n:39, 3.4%) was the least common VHD. CONCLUSION In the present study, we found that HHD was the most common comorbidity, followed by VHD, and HFrEF. Moreover, the most common VHD was mitral insufficiency and the most common CHD was ASD.
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Affiliation(s)
- Gökhan Alıcı
- Turkey, Recep Tayyip Erdogan, Somalia Mogadishu Training and Research Hospital, Mogadishu, Somalia
| | - Ömer Genç
- Department of Cardiology, Agri Training and Research Hospital, Agri, Turkey
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6
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Shaboodien G, Spracklen TF, Kamuli S, Ndibangwi P, Van Niekerk C, Ntusi NAB. Genetics of inherited cardiomyopathies in Africa. Cardiovasc Diagn Ther 2020; 10:262-278. [PMID: 32420109 DOI: 10.21037/cdt.2019.10.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCDs) is rising disproportionately in comparison to the rest of the world, affecting urban, semi-urban and rural dwellers alike. NCDs are predicted to surpass infections like human immunodeficiency virus, tuberculosis and malaria as the leading cause of mortality in SSA over the next decade. Heart failure (HF) is the dominant form of cardiovascular disease (CVD), and a leading cause of NCD in SSA. The main causes of HF in SSA are hypertension, cardiomyopathies, rheumatic heart disease, pericardial disease, and to a lesser extent, coronary heart disease. Of these, the cardiomyopathies deserve greater attention because of the relatively poor understanding of mechanisms of disease, poor outcomes and the disproportionate impact they have on young, economically active individuals. Morphofunctionally, cardiomyopathies are classified as dilated, hypertrophic, restrictive and arrhythmogenic; regardless of classification, at least half of these are inherited forms of CVD. In this review, we summarise all studies that have investigated the incidence of cardiomyopathy across Africa, with a focus on the inherited cardiomyopathies. We also review data on the molecular genetic underpinnings of cardiomyopathy in Africa, where there is a striking lack of studies reporting on the genetics of cardiomyopathy. We highlight the impact that genetic testing, through candidate gene screening, association studies and next generation sequencing technologies such as whole exome sequencing and targeted resequencing has had on the understanding of cardiomyopathy in Africa. Finally, we emphasise the need for future studies to fill large gaps in our knowledge in relation to the genetics of inherited cardiomyopathies in Africa.
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Affiliation(s)
- Gasnat Shaboodien
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Timothy F Spracklen
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen Kamuli
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Polycarp Ndibangwi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carla Van Niekerk
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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7
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Huson MAM, Kaminstein D, Kahn D, Belard S, Ganesh P, Kandoole-Kabwere V, Wallrauch C, Phiri S, Kreuels B, Heller T. Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa. Ultrasound J 2019; 11:34. [PMID: 31883027 PMCID: PMC6934640 DOI: 10.1186/s13089-019-0149-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background Point-of-care ultrasound is increasingly being used as a diagnostic tool in resource-limited settings. The majority of existing ultrasound protocols have been developed and implemented in high-resource settings. In sub-Saharan Africa (SSA), patients with heart failure of various etiologies commonly present late in the disease process, with a similar syndrome of dyspnea, edema and cardiomegaly on chest X-ray. The causes of heart failure in SSA differ from those in high-resource settings. Point-of-care ultrasound has the potential to identify the underlying etiology of heart failure, and lead to targeted therapy. Based on a literature review and weighted score of disease prevalence, diagnostic impact and difficulty in performing the ultrasound, we propose a context-specific cardiac ultrasound protocol to help differentiate patients presenting with heart failure in SSA. Results Pericardial effusion, dilated cardiomyopathy, cor pulmonale, mitral valve disease, and left ventricular hypertrophy were identified as target conditions for a focused ultrasound protocol in patients with cardiac failure and cardiomegaly in SSA. By utilizing a simplified 5-question approach with all images obtained from the subxiphoid view, the protocol is suitable for use by health care professionals with limited ultrasound experience. Conclusions The “Cardiac ultrasound for resource-limited settings (CURLS)” protocol is a context-specific algorithm designed to aid the clinician in diagnosing the five most clinically relevant etiologies of heart failure and cardiomegaly in SSA. The protocol has the potential to influence treatment decisions in patients who present with clinical signs of heart failure in resource-limited settings outside of the traditional referral institutions.
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Affiliation(s)
- Michaëla A M Huson
- Department of Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Dan Kaminstein
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Daniel Kahn
- Department of Internal Medicine, University of California, Los Angeles, CA, USA
| | - Sabine Belard
- Department of Paediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Prakash Ganesh
- Lighthouse Clinic, Kamuzu Central Hospital, Lilongwe, Malawi.,International Training and Education Centre for Health, University of Washington, Seattle, WA, USA
| | | | - Claudia Wallrauch
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany
| | - Sam Phiri
- Lighthouse Clinic, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Lilongwe, Malawi
| | - Benno Kreuels
- Department of Internal Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tom Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Lilongwe, Malawi.
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8
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Akono MN, Simo LP, Agbor VN, Njoyo SL, Mbanya D. The spectrum of heart disease among adults at the Bamenda Regional Hospital, North west Cameroon: a semi urban setting. BMC Res Notes 2019; 12:761. [PMID: 31752960 PMCID: PMC6873567 DOI: 10.1186/s13104-019-4803-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/12/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We sought to determine the spectrum of heart diseases among adult patients at the Bamenda Regional Hospital in the North West Region of Cameroon. This is a chart review of echocardiographic records. RESULTS In total, 673 records were included in our study, of which 506 had a definite heart disease. Of the 506, 93 had mixed cardiopathies. Their ages ranged from 18 to 105 years with a median age of 64.0 (Interquartile range = 47-75) years. Females accounted for a greater proportion (55.3%) of the study population. The most common echocardiographic diagnoses were hypertensive heart disease (41.1%), valvular heart disease (22.3%) and cardiomyopathies (11.4%). The prevalence of heart failure was 17.5%, with hypertensive heart disease being the leading cause.
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Affiliation(s)
| | - Larissa Pone Simo
- Faculty of Health Sciences, The University of Bamenda, Bamenda, Cameroon
| | - Valirie Ndip Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Health Research, Health Education and Research Organization (HERO), Buea, Cameroon
| | - Sylvain Laah Njoyo
- Mozogo Sub-divisional Hospital, Mayo-Moskota, Far North Region, Mozogo, Cameroon
| | - Dora Mbanya
- Faculty of Health Sciences, The University of Bamenda, Bamenda, Cameroon
- Yaoundé University Teaching Hospital (YUTH), Yaoundé, Cameroon
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9
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Noubiap JJ, Agbor VN, Ndoadoumgue AL, Nkeck JR, Kamguia A, Nyaga UF, Ntsekhe M. Epidemiology of pericardial diseases in Africa: a systematic scoping review. Heart 2018; 105:180-188. [PMID: 30415206 DOI: 10.1136/heartjnl-2018-313922] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/21/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This scoping review sought to summarise available data on the prevalence, aetiology, diagnosis, treatment and outcome of pericardial disease in Africa. METHODS We searched PubMed, Scopus and African Journals Online from 1 January 1967 to 30 July 2017 to identify all studies published on the prevalence, aetiologies, diagnosis, treatment and outcomes of pericardial diseases in adults residing in Africa. RESULTS 36 studies were included. The prevalence of pericardial diseases varies widely according to the population of interest: about 1.1% among people with cardiac complaints, between 3.3% and 6.8% among two large cohorts of patients with heart failure and up to 46.5% in an HIV-infected population with cardiac symptoms. Tuberculosis is the most frequent cause of pericardial diseases in both HIV-uninfected and HIV-infected populations. Patients with tuberculous pericarditis present mostly with effusive pericarditis (79.5%), effusive constrictive pericarditis (15.1%) and myopericarditis (13%); a large proportion of them (up to 20%) present in cardiac tamponade. The aetiological diagnosis of pericardial diseases is challenging in African resource-limited settings, especially for tuberculous pericarditis for which the diagnosis is not definite in many cases. The outcome of these diseases remains poor, with mortality rates between 18% and 25% despite seemingly appropriate treatment approaches. Mortality is highest among patients with tuberculous pericarditis especially those coinfected with HIV. CONCLUSION Pericardial diseases are a significant cause of morbidity and mortality in Africa, especially in HIV-infected individuals. Tuberculosis is the most frequent cause of pericardial diseases, and it is associated with poor outcomes.
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Affiliation(s)
- Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Valirie Ndip Agbor
- Ibal Sub-divisional Hospital, Oku, Cameroon.,Department of Clinical Research, Health Education and Research Organization (HERO), Cameroon
| | | | - Jan René Nkeck
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Arnaud Kamguia
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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10
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Nkoke C, Dzudie A, Makoge C, Luchuo EB, Jingi AM, Kingue S. Rheumatic heart disease in the South West region of Cameroon: a hospital based echocardiographic study. BMC Res Notes 2018; 11:221. [PMID: 29615091 PMCID: PMC5883525 DOI: 10.1186/s13104-018-3341-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/30/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Rheumatic heart disease (RHD) prevails as a major public health problem in sub-Saharan Africa. In Cameroon, reports on RHD have been so far limited to a few cities. We sought to describe the demographic, clinical and echocardiographic features of rheumatic heart disease in the Buea Regional Hospital, South West region of Cameroon. Echocardiography reports between June 2016 and June 2017 were reviewed. The diagnosis of RHD was based on the World Heart Federation Criteria for the diagnosis of RHD. Results A total of 669 echocardiograms were performed over the 1 year study period. Twenty-one (3.1%) had a definite echocardiographic diagnosis of RHD. There were 14 (66.7%) females. The age range was 13–94 years with a mean age of 47.8 ± 20.3 years. The most common indications for echocardiography were heart failure (47.6%), and dyspnea (42.9%). The mitral valve was the most commonly affected valve in 80.9% of cases. The most common valve lesion was isolated mitral stenosis (42.9%), followed by isolated mitral regurgitation (28.6%). There were no lesions on the tricuspid and pulmonic valves. Severe lesions were found in 80.9% of the patients. The complications were pulmonary hypertension (66.7%) and atrial fibrillation (9.5%).
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Affiliation(s)
- Clovis Nkoke
- Buea Regional Hospital, Buea, South West Region, Cameroon. .,Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.
| | - Anastase Dzudie
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon.,Douala General Hospital, Douala, Cameroon
| | - Christelle Makoge
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Engelbert Bain Luchuo
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ahmadou Musa Jingi
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Samuel Kingue
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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11
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Agbor VN, Essouma M, Ntusi NA, Nyaga UF, Bigna JJ, Noubiap JJ. Heart failure in sub-Saharan Africa: A contemporaneous systematic review and meta-analysis. Int J Cardiol 2018; 257:207-215. [DOI: 10.1016/j.ijcard.2017.12.048] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 01/13/2023]
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12
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Nyaga UF, Bigna JJ, Agbor VN, Essouma M, Ntusi NA, Noubiap JJ. Data on the epidemiology of heart failure in Sub-Saharan Africa. Data Brief 2018; 17:1218-1239. [PMID: 29876481 PMCID: PMC5988512 DOI: 10.1016/j.dib.2018.01.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 12/04/2022] Open
Abstract
In Sub-Saharan Africa (SSA), chronic non-communicable diseases and cardiovascular diseases in particular, are progressively taking over infectious diseases as the leading cause of morbidity and mortality. Heart failure is a major public health problem in the region. We summarize here available data on the prevalence, aetiologies, treatment, rates and predictors of mortality due to heart failure in SSA.
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Affiliation(s)
- Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Joel Bigna
- Faculty of Medicine, University of Paris Sud XI, Le Kremlin Bicêtre, Paris, France
| | | | - Mickael Essouma
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ntobeko A.B. Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Center, University of Cape Town, Cape Town, South Africa
| | - Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Nkoke C, Makoge C, Dzudie A, Mfeukeu LK, Luchuo EB, Menanga A, Kingue S. A predominance of hypertensive heart disease among patients with cardiac disease in Buea, a semi-urban setting, South West Region of Cameroon. BMC Res Notes 2017; 10:684. [PMID: 29202813 PMCID: PMC5715493 DOI: 10.1186/s13104-017-3034-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/30/2017] [Indexed: 01/09/2023] Open
Abstract
Objective The pattern of heart disease is diverse within and among world regions. The little data on the spectrum of heart disease in Cameroon has been so far limited to major cities. We sought to describe the pattern of heart disease in Buea, the South West Region of Cameroon, a semi-urban setting. This was a descriptive cross-sectional study. Between June 2016 and April 2017 the echocardiography register of the Buea Regional Hospital was surveyed. We extracted data on the age, sex and echocardiographic diagnosis. Results Out of 529 patients who underwent echocardiography, 239 (45.2%) had a definite heart disease. There were 137 (57.3%) females. The mean age was 58 years (range 3–94 years). The most common echocardiographic diagnoses were hypertensive heart disease (43.2%), dilated cardiomyopathies (17.6%), ischemic heart diseases (9.6%), and cor pulmonale (8.8%). Rheumatic heart disease affected 6.7% of the patients. The most common rheumatic heart disease was mitral stenosis followed by mitral regurgitation. Congenital heart disease represented 2.1% and 5 patients (2.1%) had pulmonary hypertension. Hypertensive heart disease is the most common cardiac disease in this semi-urban region in Cameroon. Rheumatic heart disease still affects a sizable proportion of patients. Prevention of cardiac disease in our setting should focus on mass screening, the treatment and control of hypertension.
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Affiliation(s)
- Clovis Nkoke
- Buea Regional Hospital, Buea, South West Region, Cameroon.
| | - Christelle Makoge
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | | | - Liliane Kuate Mfeukeu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Engelbert Bain Luchuo
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Alain Menanga
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Samuel Kingue
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
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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: 157] [Impact Index Per Article: 22.4] [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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Chelo D, Nguefack F, Menanga AP, Ngo Um S, Gody JC, Tatah SA, Koki Ndombo PO. Spectrum of heart diseases in children: an echocardiographic study of 1,666 subjects in a pediatric hospital, Yaounde, Cameroon. Cardiovasc Diagn Ther 2016; 6:10-9. [PMID: 26885487 PMCID: PMC4731579 DOI: 10.3978/j.issn.2223-3652.2015.11.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/29/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Children's health programs in Sub-Saharan Africa have always been oriented primarily to infectious diseases and malnutrition. We are witnessing in the early 21(st) century an epidemiological transition marked by the decline of old diseases and the identification of new diseases including heart disease. Therefore, it is necessary to describe the spectrum of these diseases in order to better prepare health workers to these new challenges. METHODS We conducted a cross-sectional study focused on heart disease diagnosed by echocardiography in children seen from January 2006 to December 2014 in a pediatric hospital of Yaounde. We collected socio-demographic data and the types of heart disease from registers, patients files as well as the electronic database of echocardiographic records. RESULTS A total of 2,235 patients underwent echocardiographic examination during the study period including 1,666 subjects with heart disease. Congenital cardiopathies were found in 1,230 (73.8%) patients and acquired abnormalities in 429 (25.8%). Seven children (0.4%) had a combination of both types. Congenital heart defects (CHD) were dominated by ventricular septal defect (VSD). Acquired heart disease was mostly rheumatic valvulopathies. Dyspnea on exertion was the most frequent presenting complaint (87.6%). Discovery of a heart murmur was the principal clinical finding on physical examination (81.4%). The median age was 9 months for congenital heart disease and 132 months for acquired heart disease. CONCLUSIONS As infectious diseases recede and the diagnostic facilities are improving, pediatric heart diseases occupy a more important position in the spectrum of pediatric diseases in our context. However, the ability to evoke the diagnosis remains unsatisfactory by the majority of health personnel and therefore needs to be improved. Apart from congenital heart diseases, the impact of acquired heart diseases, rheumatic valvulopathy being the highest ranking, is remarkable in pediatrics. Awareness of health personnel for better management of child tonsillitis is more than ever a necessity. This preventive attitude of rheumatic heart disease is the main attitude available in our disadvantaged economic environment.
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McKavanagh P, Booth K, Blair L, McNeilly G, Varadarajan B, Nzewi O. Addressing discrepancies: personal experience of a cardiac mission programme in Africa. Int J Cardiol 2014; 177:794-9. [PMID: 25449501 DOI: 10.1016/j.ijcard.2014.09.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
Abstract
The worldwide incidence of cardiovascular disease (CVD) is increasing, reflecting a combination of ongoing infective diseases and a rapid rise in traditional 'western' risk factors. It is estimated that in the next 20 years that CVD be the leading cause of death in developing nations. There are high incidences of rheumatic heart disease, coronary artery disease, cardiomyopathies, uncorrected congenital heart disease and human immunodeficiency virus (HIV) associated disease in many low-income countries. Such high levels combined with a lack of diagnostic tests and therapeutic options means mortality and morbidity rates are high. A number of charities and organizations have tried to address the discrepancy of cardiac care within developing areas although the needs remain great. However there is no one global cardiac organization that coordinates such humanitarian work. The challenges of missionary work include the need for appropriate facilities, financial constraints of clinical consumables, and lack of education of local healthcare staff, making the move away from the mission model difficult. The strategy for delivery of care in developing countries should be long term educational and technical support, so that local case volumes increase. However it must be realized that there are many different levels of local services within developing nations with different health and educational needs, including some countries with very high facilities and skills levels, yet high case loads. This paper highlights the personal experience of our organization and the types of diseases encountered in developing countries.
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Affiliation(s)
- Peter McKavanagh
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom.
| | - Karen Booth
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Laura Blair
- Save a Heart Charity, Belfast, United Kingdom; 352 Healthcare, Belfast, United Kingdom
| | - Graham McNeilly
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Bharathi Varadarajan
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
| | - Onyekwelu Nzewi
- Royal Victoria Hospital, Belfast, United Kingdom; Save a Heart Charity, Belfast, United Kingdom
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Jingi AM, Noubiap JJN, Yonta EW, Kamdem P, Obama JM, Kingue S. A Centre for the Diagnosis and Treatment of Tuberculosis (CDT) in a resource-limited setting: a dragnet for patients with heart disease? ACTA ACUST UNITED AC 2014; 72:26. [PMID: 25126419 PMCID: PMC4132523 DOI: 10.1186/2049-3258-72-26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/03/2014] [Indexed: 11/17/2022]
Abstract
Background Cardiovascular disease is a growing public health problem in sub-Saharan Africa. Cough and dyspnea are symptoms of both lung diseases and heart failure. This study aimed at determining the contribution of cardiac diseases versus pulmonary diseases in the etiological profile of patients presenting with cough and dyspnea in a Center for the Diagnosis and Treatment of Tuberculosis (CDT), in a semi-rural area in Cameroon. Methods This is a cross-sectional analysis of data from patients aged 18 years or more who consulted for cough and or dyspnea between December 2009 and December 2010 at the CDT of Lafe-Baleng, Bafoussam, Cameroon. Results A total of 1196 patients were received for various complaints during the study period; 348 (29.1%) of them presented with cough and or dyspnea, and were included in the study. 186 patients (53.4%; 95% CI: 48.2-58.6) had a pure cardiac disease, while 122 patients (35.1%; 95% CI: 30.2-40.2) had a pulmonary disease. The prevalence of hypertension was 50.9%, and hypertensive heart disease was the most frequent cardiac disease with a prevalence rate of 37.6%. Heart failure was diagnosed in 222 patients, representing 63.8% (95% CI: 58.9-68.9) of patients with cough and or dyspnea, and 18.6% (95% CI: 16.5-21.0) of all the patients received at the CDT of Lafe-Baleng during the study period. Compared to patients with a pulmonary disease, patients with cardiac disease were older (p < 0.001) and more likely to present with dyspnea (p < 0.001) and to have hypertension (p < 0.001). Conclusion We found a high prevalence of heart failure in this Centre for the Diagnosis and Treatment of Tuberculosis thus, a veritable dragnet for patients with heart disease. Our findings emphasize the urgent need to increase the access to cardiovascular care and to continuously raise the awareness of the communities on cardiovascular diseases in Cameroon.
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Affiliation(s)
- Ahmadou M Jingi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Edvine Wawo Yonta
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; Department of Internal Medicine, Yaoundé Teaching Hospital, Yaoundé, Cameroon
| | | | - Joël Marie Obama
- Department of Internal Medicine, Bertoua Regional Hospital, Bertoua, Cameroon
| | - Samuel Kingue
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ; Department of Internal Medicine, Yaoundé General Hospital, Yaoundé, Cameroon
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Orisakwe OE. Lead and cadmium in public health in Nigeria: physicians neglect and pitfall in patient management. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:61-70. [PMID: 24696827 PMCID: PMC3968567 DOI: 10.4103/1947-2714.127740] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Low-level heavy metals exposure may contribute much more toward the causation of chronic disease and impaired functioning than previously thought. Among the suggested preventive and intervention measures for the control of renal diseases are the reduction in the exposure to heavy metals. Although these indicate knowledge and awareness of possible role of some heavy metals in the etiogenesis of some chronic diseases by Nigerian Physicians, heavy metal assay as diagnostic guide in patient management is often omitted in most healthcare settings. This is a synoptic capture of the increased incidence and prevalence of some metabolic disorders where heavy metals may be implicated. A search of the terms heavy metal exposure, source, toxicity, metabolic disorders, poisoning in Nigeria, in bibliographical databases (in English language) such as PubMed, Scopus, Google Scholar, and Africa Journal Online (AJOL) digital library was conducted. Leaded gasoline, refuse dumping, absence of poison information centers, and poor record keeping characterize environmental health in Nigeria. Lead and cadmium are of most significant public health importance in Nigeria. The recognition and inclusion of heavy metals assays in the diagnosis of metabolic disorders may ensure early diagnosis and improve management.
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Affiliation(s)
- Orish Ebere Orisakwe
- Toxicology Unit, Clinical Pharmacy, Faculty of Pharmacy, University of Port Harcourt Rivers State Nigeria, Port Harcourt Nigeria
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Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Ajani AA, Adesina JO, Durodola A, Sliwa K. Contemporary profile of acute heart failure in Southern Nigeria: data from the Abeokuta Heart Failure Clinical Registry. JACC-HEART FAILURE 2014; 2:250-9. [PMID: 24952692 DOI: 10.1016/j.jchf.2013.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to determine the contemporary profile, clinical characteristics, and intrahospital outcomes of acute heart failure (AHF) in an African urban community. BACKGROUND There are limited data on the current burden and characteristics of AHF in Nigerian Africans. METHODS Comprehensive and detailed clinical and sociodemographic data were prospectively collected from 452 consecutive patients presenting with AHF to the only tertiary hospital in Abeokuta, Nigeria (population about 1 million) over a 2-year period. RESULTS The mean age was 56.6 ± 15.3 years (57.3 ± 13.4 years for men, 55.7 ± 17.1 years for women), and 204 patients (45.1%) were women. Overall, 415 subjects (91.8%) presented with de novo AHF. The most common risk factor for heart failure was hypertension (pre-existing in 64.3% of patients). Type 2 diabetes mellitus was present in 41 patients (10.0%). Hypertensive heart failure was the most common etiological cause of heart failure, responsible for 78.5% of cases. Dilated cardiomyopathy (7.5%), cor pulmonale (4.4%), pericardial disease (3.3%), rheumatic heart disease (2.4%), and ischemic heart disease were less common (0.4%) causes. The majority of subjects (71.2%) presented with left ventricular dysfunction (mean left ventricular ejection fraction 43.9 ± 9.0%), with valvular dysfunction and abnormal left ventricular geometry frequently documented. The mean duration of hospital stay was 11.4 ± 9.1 days, and intrahospital mortality was 3.8%. CONCLUSIONS Compared with those in high-income countries, patients presenting with AHF in Abeokuta, Nigeria, are relatively younger and still of working age. It is also more common in men and associated with severe symptoms because of late presentation. Intrahospital mortality is similar to that in other parts of the world.
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Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gail D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokua, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokua, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Julius O Adesina
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hatter Institute for Cardiovascular Research in Africa & IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Jingi AM, Noubiap JJN, Kamdem P, Wawo Yonta E, Temfack E, Kouam Kouam C, Kingue S. The spectrum of cardiac disease in the West Region of Cameroon: a hospital-based cross-sectional study. Int Arch Med 2013; 6:44. [PMID: 24139520 PMCID: PMC4015963 DOI: 10.1186/1755-7682-6-44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/13/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cardiovascular disease is a growing public health problem in Africa. The extent of heart disease in Cameroon remains largely unknown. This study aimed at reporting the etiology of cardiac disease in a cardiologic clinic situated in a semi-urban area in the West region of Cameroon. METHODS This is an analysis of echocardiographic diagnosis of cardiac disease done between July 2008 and October 2010 at the "Centre Medical de la Trinité" in the West region of Cameroon. Data included age, sex and echocardiographic findings. RESULTS A total of 1252 patients presented with abnormal echocardiograms, 60.4% (n = 756) being female and 85.8% (n = 1074) aged over 50 years. Overall, the most important conditions were hypertensive heart disease (41.5%, n = 520) and cardiomyopathies (30.5%, n = 382). Among patients aged less than 10 years, congenital heart diseases were the most frequent (52.4%, n = 22), and rheumatic heart disease was the most important cardiac condition in patients aged 10 to 19 years (62.1%, n = 18) and those aged 20 to 39 years (53.3%, n = 8). Congenital heart diseases included persistent ductus arteriosus (27.6%, n = 8), tetralogy of Fallot (20.7%, n = 6) and inter-atria/interventricular communication (20.7%, n = 6). CONCLUSION Hypertension is the leading cause of cardiac disease among the elderly in our setting, emphasizing the necessity to strengthen the preventive strategies against hypertension in Cameroon. Rheumatic heart disease and congenital heart disease frequent in children and youths highlight the need of early detection and treatment of throat infections, and of routine cardiac surgery services in Cameroon.
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Adebayo RA, Akinwusi PO, Balogun MO, Akintomide AO, Adeyeye VO, Abiodun OO, Bisiriyu LA, Ogunyemi SA, Ajayi EA, Ajayi OE, Oyedeji AT. Two-dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria: a prospective study of 2501 subjects. Int J Gen Med 2013; 6:541-4. [PMID: 23861593 PMCID: PMC3704451 DOI: 10.2147/ijgm.s43614] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Echocardiography remains a key noninvasive cardiac investigative tool in the management of patients, especially in a developing economy like Nigeria. In this study, we investigated the indications for transthoracic echocardiography and spectrum of cardiac disease found in patients referred to our cardiac unit for echocardiography. Methods A prospective two-dimensional, pulsed, continuous, and color-flow Doppler echocardiographic evaluation was done using the transthoracic approach in 2501 patients over an eight-year period. Univariate data analysis was performed for mean age, gender, clinical indications, and diagnoses. Results The subject age range was less than 12 months to 97 years (mean 52.39 years). There were 1352 (54.06%) males and 1149 (45.94%) females. The most common indication for echocardiography was hypertension (52.1%) followed by congestive cardiac failure (13.9%). Others were for screening (6.1%), arrhythmias (5%), cerebrovascular disease (5%), chest pain (3.3%), chronic kidney disease (3.2%), congenital heart disease (2.6%), cardiomyopathy (1.8%), rheumatic heart disease (1.7%), diabetes mellitus (1.3%), thyrocardiac disease (1.2%), ischemic heart disease (1.2%), and pericardial disease (1.1%). The echocardiographic diagnosis was hypertensive heart disease in 59.4% of subjects and normal in 14.1%. Other echocardiographic diagnoses included rheumatic heart disease (3.1%), congenital heart disease (2.1%), cardiomyopathy (1.7%), pericardial disease (1.1%), and ischemic heart disease (0.1%). Conclusion Hypertension and its cardiac complications is the most common echocardiographic indication and diagnosis at our unit.
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Affiliation(s)
- Rasaaq Ayodele Adebayo
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State
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Anzouan-Kacou JB, Siransy E, Nchoh-Mottoh MP, Ekou A, Bamba-Kamagaté D, Kadio EM. [Transthoracic echocardiography in a heart institute in Abidjan (Ivory Coast): Indications and evaluation of the request appropriateness]. Ann Cardiol Angeiol (Paris) 2013; 63:1-6. [PMID: 23806860 DOI: 10.1016/j.ancard.2013.04.015] [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] [Received: 10/25/2012] [Accepted: 04/27/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to clarify the clinical situations motivating indications of transthoracic echocardiography (TTE) in a cardiology institute in Côte d'Ivoire and to assess the appropriateness of indications. PATIENTS AND METHODS This is a prospective and observational study conducted over a period of 6 months. The 1733 enrolled were classified according to the indications and their relevance defined by the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Echocardiography and the American Heart Association (ACCF/ASE/AHA). RESULTS In five cases (0.3%), indications were not listed in the document ACCF/ASE/AHA. The most common indication was the initial evaluation of hypertension (HTA) and suspicion of hypertensive heart disease (47.3%). All indications, the assessment in the context of hypertension represented 853 examinations (49.2%). Heart failure accounted for 5.3% of indications, but consisted of 302 applications (17.4%) when was associated hypertension with signs suggestive of heart failure. Requests were considered as appropriate in 95.3%, inappropriate in 3.2% and uncertain in 1.6%. In the group of inappropriate indications patients were significantly younger, and were examinations more often normal and less often absolutely abnormal. CONCLUSION The profile of cardiovascular morbidity in our institution is dominated by the spectrum of hypertension and heart failure. Each indication must be balanced for the profitability of the ETT.
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Affiliation(s)
- J B Anzouan-Kacou
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire.
| | - E Siransy
- Laboratoire de physiologie et d'explorations fonctionnelles, UFR sciences médicales d'Abidjan, Abidjan, Côte d'Ivoire
| | - M P Nchoh-Mottoh
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - A Ekou
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - D Bamba-Kamagaté
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
| | - E M Kadio
- Service des explorations externes, institut de cardiologie d'Abidjan, BP V 206, Abidjan, Côte d'Ivoire
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Akinwusi PO, Peter JO, Oyedeji AT, Odeyemi AO. The new face of rheumatic heart disease in South West Nigeria. Int J Gen Med 2013; 6:375-81. [PMID: 23723716 PMCID: PMC3666550 DOI: 10.2147/ijgm.s44289] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the current prevalence of rheumatic heart disease (RHD), clinical features, types of valvular lesions, complications and mortality, at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, South West Nigeria. METHODS We conducted a retrospective, descriptive study of all the cases of RHD seen in the medical outpatient clinics and wards of LAUTECH for 9 years, from January 2003 to December 2011. Statistical analysis of data obtained was done using SPSS 16. RESULTS The total number of attendees of all the medical outpatient clinics during the 9-year period was 67,378, with a subset of 9423 attending the cardiology clinic. There were 11 cases of RHD, which translates to a prevalence of 0.16/1000 and 1.2/1000 for medical outpatient clinics and the cardiology clinic respectively. The mean age of the patients was 25.64 ± 9.65 years, age range 14-40 years and male to female ratio of 1:1.2. The most common valve affected was mitral (90.9%), followed by the aortic (36.4%), and the tricuspid (18.2%). Mitral and aortic lesions coexisted in 18.2% of the patients, and late presentation was common in all RHD cases. Heart failure was the most common complication (90.9%). Other complications were secondary pulmonary hypertension (36.4%), infective endocarditis (27.3%), atrial fibrillation (27.3%), cardioembolic cerebrovascular disease (18.2%), and atrial flutter (9.1%). Mortality was 9.1%, while only one patient (9.1%) had definitive surgery. Financial constraints precluded others from having definitive surgery. CONCLUSION The prevalence of RHD has declined considerably as a result of improvements in the primary health care delivery system, with widespread use of appropriate antibiotic therapy for sore throats resulting in the prevention of rheumatic fever and RHD. However, late presentation is still very common, hence we advocate a more aggressive drive to make the Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease functional in our practice area.
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Affiliation(s)
- Patience Olayinka Akinwusi
- Department of Medicine, College of Health Sciences, Osun State University, Osogbo, Osun State, Nigeria
- Department of Medicine, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria
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Ntsekhe M, Damasceno A. Recent advances in the epidemiology, outcome, and prevention of myocardial infarction and stroke in sub-Saharan Africa. Heart 2013; 99:1230-5. [PMID: 23680888 DOI: 10.1136/heartjnl-2012-303585] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The early part of the new millennium witnessed reports of a growing burden of cardiovascular disease in Sub-Saharan Africa (SSA). However the contribution of ischemic heart disease and stroke to this increasing burden relative to that caused by hypertensive heart disease, cardiomyopathy and rheumatic heart disease was not clear. Over the last decade, data from the continent has begun to clarify this issue and suggests three main points. The burden of ischemic heart disease relative to other causes of heart disease remains low particularly in the black Africans majority. Stroke caused predominantly by hypertension is now a major cause of disability and premature death. Third, the burden of risk factors for atherosclerosis is increasing rapidly in most urban and some rural regions. A concerted effort to understand the primary drivers of this increase in cardiac risk factors is required to prevent a future epidemic of atherosclerosis and its sequelae.
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Affiliation(s)
- Mpiko Ntsekhe
- Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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25
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Akinwusi PO, Adeniji AO, Atanda OO, Adekunle AD. Hospital-based incidence of maternal heart failure during pregnancy in Nigeria. Int J Gen Med 2013; 6:201-7. [PMID: 23589699 PMCID: PMC3625026 DOI: 10.2147/ijgm.s42326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose To determine the incidence of heart failure during pregnancy and incriminated cardiac lesions, as well as maternal and fetal outcomes in Ladoke Akintola University of Technology Teaching Hospital (LTH), Osogbo, Southwest Nigeria. Methods This study was a retrospective, descriptive review of all cases of heart failure during pregnancy based on data retrieved from the medical records of LTH over a 7-year period from January 2004 to December 2010. Analysis of these data was carried out using SPSS 17. Ethical clearance was obtained from the Ethical Committee of LTH. Results A total of 4523 patients delivered babies over the 7-year period, ten (2.2/1000) of which had cardiac decompensation. All patients were not registered at LTH for antenatal care (unbooked), with 70% of them aged 18–24 years. Fifty percent were primigravidae and the majority of them presented with symptoms in the second and third trimester. There were two cases of maternal deaths recorded and three cases of fetal/perinatal mortality. Only one case of congenital heart disease (pulmonary stenosis) and no cases of rheumatic heart disease were found. Conclusion The data suggests that heart failure during pregnancy is uncommon in Southwest Nigeria. However, it occurs more often in young, unbooked primigravid women. Efforts should be aimed at encouraging early booking for antenatal care and a full cardiovascular evaluation to prevent associated maternal and fetal/perinatal morbidity and mortality.
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Affiliation(s)
- Patience Olayinka Akinwusi
- Department of Medicine, College of Health Sciences, Osun State University ; Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria
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Falase B, Sanusi M, Majekodunmi A, Ajose I, Idowu A, Oke D. The cost of open heart surgery in Nigeria. Pan Afr Med J 2013; 14:61. [PMID: 23565308 PMCID: PMC3617611 DOI: 10.11604/pamj.2013.14.61.2162] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/03/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction Open Heart Surgery (OHS) is not commonly practiced in Nigeria and most patients who require OHS are referred abroad. There has recently been a resurgence of interest in establishing OHS services in Nigeria but the cost is unknown. The aim of this study was to determine the direct cost of OHS procedures in Nigeria. Methods The study was performed prospectively from November to December 2011. Three concurrent operations were selected as being representative of the scope of surgery offered at our institution. These procedures were Atrial Septal Defect (ASD) Repair, Off Pump Coronary Artery Bypass Grafting (OPCAB) and Mitral Valve Replacement (MVR). Cost categories contributing to direct costs of OHS (Investigations, Drugs, Perfusion, Theatre, Intensive Care, Honorarium and Hospital Stay) were tracked to determine the total direct cost for the 3 selected OHS procedures. Results ASD repair cost $ 6,230 (Drugs $600, Intensive Care $410, Investigations $955, Perfusion $1080, Theatre $1360, Honorarium $925, Hospital Stay $900). OPCAB cost $8,430 (Drugs $740, Intensive Care $625, Investigations $3,020, Perfusion $915, Theatre $1305, Honorarium $925, Hospital Stay $900). MVR with a bioprosthetic valve cost $11,200 (Drugs $1200, Intensive Care $500, Investigations $3040, Perfusion $1100, Theatre $3,535, Honorarium $925, Hospital Stay $900). Conclusion The direct cost of OHS in Nigeria currently ranges between $6,230 and $11,200. These costs compare favorably with the cost of OHS abroad and can serve as a financial incentive to patients, sponsors and stakeholders to have OHS procedures done in Nigeria.
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Affiliation(s)
- Bode Falase
- Cardiothoracic Division, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Falase B, Sanusi M, Majekodunmi A, Animasahun B, Ajose I, Idowu A, Oke A. Open heart surgery in Nigeria; a work in progress. J Cardiothorac Surg 2013; 8:6. [PMID: 23311435 PMCID: PMC3574006 DOI: 10.1186/1749-8090-8-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/07/2013] [Indexed: 03/22/2024] Open
Abstract
Background There has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme. Methods This is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome. Results 51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model. Conclusions The Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar challenges will need to be overcome by other cardiac stakeholders if other OHS programs are to be developed and sustained in Nigeria.
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Affiliation(s)
- Bode Falase
- Cardiothoracic Division, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
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Akinwusi PO, Odeyemi AO. The changing pattern of endomyocardial fibrosis in South-west Nigeria. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2012; 6:163-8. [PMID: 23226077 PMCID: PMC3511056 DOI: 10.4137/cmc.s10141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy, the prevalence of which is declining globally. This study was carried out to determine if there were changing patterns in its local prevalence in South-West Nigeria. Methods: We reviewed the medical records of all patients admitted to or attending the cardiology clinic or medical outpatient/specialty clinics in the Department of Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South-West Nigeria. Medical data for those with EMF from January 2003 to December 2009 were retrieved and analyzed. Results: Only three cases of EMF were identified from a total of 12,794 medical patients containing a subset of 7956 cardiac patients. The prevalence of EMF was 0.02% and 0.04% for medical and cardiac patients, respectively. All the patients with EMF were in the second or third decades of life, and had right ventricular EMF and atrial fibrillation, but no eosinophilia. Conclusion: This study shows that the prevalence of EMF has declined in the study area from 10% in the 1960s and 1970s to 0.02% for medical cases and 0.04% for cardiac cases in the first decade of the 21st century. Right ventricular EMF still predominates, but without eosinophilia. Improved health care delivery’s positive impact on the control of communicable diseases might be responsible for these observed changes. More work needs to be done both within and outside Nigeria to follow this trend and unravel the mystery surrounding this poorly understood cardiac disease.
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Affiliation(s)
- Patience Olayinka Akinwusi
- Department of Medicine, College of Health Sciences, Osun State University. ; Department of Medicine, Ladoke Akintola University Teaching Hospital, Osogbo, South-West Nigeria
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Koech MM, Barasa F, Ng'eno TK. Why prevention of rheumatic heart disease should be a component of primary healthcare. J Trop Pediatr 2012; 58:414-5. [PMID: 22228821 DOI: 10.1093/tropej/fmr101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ogah OS. Cardiomegaly in ghana: an autopsy study. Ghana Med J 2009; 43:93-94. [PMID: 21326850 PMCID: PMC3039234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Okechukwu Samuel Ogah
- Federal Medical Centre Department of Medicine Bisi Onabanjo Way, Idi-Aba, Abeokuta Ogun State PMB 3031 Nigeria
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