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LeBlanc KE, Baer-Sinnott S, Lancaster KJ, Campos H, Lau KHK, Tucker KL, Kushi LH, Willett WC. Perspective: Beyond the Mediterranean Diet-Exploring Latin American, Asian, and African Heritage Diets as Cultural Models of Healthy Eating. Adv Nutr 2024; 15:100221. [PMID: 38604411 PMCID: PMC11087705 DOI: 10.1016/j.advnut.2024.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
The Mediterranean diet is a well-studied cultural model of healthy eating, yet research on healthy models from other cultures and cuisines has been limited. This perspective article summarizes the components of traditional Latin American, Asian, and African heritage diets, their association with diet quality and markers of health, and implications for nutrition programs and policy. Though these diets differ in specific foods and flavors, we present a common thread that emphasizes healthful plant foods and that is consistent with high dietary quality and low rates of major causes of disability and deaths. In this perspective, we propose that nutrition interventions that incorporate these cultural models of healthy eating show promise, though further research is needed to determine health outcomes and best practices for implementation.
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Affiliation(s)
| | | | - Kristie J Lancaster
- Department of Nutrition and Food Studies, New York University, New York, NY, United States
| | - Hannia Campos
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Katherine L Tucker
- Department of Biomedical & Nutritional Sciences and Center for Population Health, University of Massachusetts Lowell, Lowell, MA, United States
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Walter C Willett
- Department of Nutrition, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
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Anyanwu C, Bikomeye JC, Beyer KM. The impact of environmental conditions on non-communicable diseases in sub-Saharan Africa: A scoping review of epidemiologic evidence. J Glob Health 2024; 14:04003. [PMID: 38419464 PMCID: PMC10902803 DOI: 10.7189/jogh.14.04003] [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: 03/02/2024] Open
Abstract
Background The burden of non-communicable diseases (NCDs) in sub-Saharan Africa (SSA) is increasing. Environmental conditions such as heavy metals and air pollution have been linked with the incidence and mortality of chronic diseases such as cancer, as well as cardiovascular and respiratory diseases. We aimed to scope the current state of evidence on the impact of environmental conditions on NCDs in SSA. Methods We conducted a scoping review to identify environmental conditions linked with NCDs in SSA by identifying studies published from January 1986 through February 2023. We searched African Index Medicus, Ovid Medline, Scopus, Web of Science, and Greenfile. Using the PICOS study selection criteria, we identified studies conducted in SSA focussed on physical environmental exposures and incidence, prevalence, and mortality of NCDs. We included only epidemiologic or quantitative studies. Results We identified 6754 articles from electronic database searches; only 36 met our inclusion criteria and were qualitatively synthesised. Two studies were conducted in multiple SSA countries, while 34 were conducted across ten countries in SSA. Air pollution (58.3%) was the most common type of environmental exposure reported, followed by exposure to dust (19.4%), meteorological variables (13.8%), heavy metals (2.7%), soil radioactivity (2.7%), and neighbourhood greenness (2.7%). The examined NCDs included respiratory diseases (69.4%), cancer (2.7%), stroke (5.5%), diabetes (2.7%), and two or more chronic diseases (19.4%). The study results suggest an association between environmental exposures and NCDs, particularly for respiratory diseases. Only seven studies found a null association between environmental conditions and chronic diseases. Conclusions There is a growing body of research on environmental conditions and chronic diseases in the SSA region. Although some cities in SSA have started implementing environmental monitoring and control measures, there remain high levels of environmental pollution. Investment can focus on improving environmental control measures and disease surveillance.
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Rezaianzadeh A, Niazkar HR, Rezaeianzadeh R, Jafari F, Rahimikazerooni S, Ghoddusi Johari M, Zare M, Hosseini SV. Kharameh cohort study (KHCS) on non-communicable diseases and preliminary findings of 3-year follow-up. BMJ Open 2024; 14:e077116. [PMID: 38331866 PMCID: PMC10860034 DOI: 10.1136/bmjopen-2023-077116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE The Kharameh cohort study (KHCS) is one branch of the 'Prospective Epidemiological Research Studies in Iran', located in the south of Iran. The enrolment phase of KHCS spanned from April 2015 to March 2017, during which urban and rural residents of Kharameh were enrolled in the study. KHCS aims to investigate the incidence of non-communicable diseases (NCDs) such as hypertension, diabetes mellitus, cardiovascular diseases and cancer, and its related risk factors in a 15-year follow-up. PARTICIPANTS KHCS was designed to recruit 10 000 individuals aged 40-70 years old from both urban and rural areas of Kharameh. Thus, a total of 10 800 individuals aged 40-70 years of age were invited and, finally, 10 663 subjects were accepted to participate, with a participation rate of 98.7%. FINDINGS TO DATE Of the 10 663 participants, 5944 (55.7%) were women, and 6801 (63.7%) were rural residents. The mean age of the participants was 51.9±8.2 years. 41.8% of the participants were aged 40-49, 35.2% were aged 50-59 and the remaining 23% were 60-70 years old. Until March 2020 (first 3 years of follow-up), the total number of patients diagnosed with NCDs was 1565. Hypertension, type 2 diabetes and acute ischaemic heart disease were the most common NCDs. Furthermore, the total number of deaths during the first 3 years of follow-up was 312, with cardiovascular diseases (38.7%) as the most common cause of death, followed by cerebrovascular diseases (11.8%) and cancer (16.2%). FUTURE PLANS The remaining 12 years of follow-up will inevitably shed light on the genetic, lifestyle/socioeconomic status, and environmental risk and protective factors of NCDs.
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Affiliation(s)
- Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Hamid Reza Niazkar
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Ramin Rezaeianzadeh
- Department of Medicine, British Columbia Open University, Kamloops, British Columbia, Canada
| | - Fatemeh Jafari
- Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Salar Rahimikazerooni
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Masoumeh Ghoddusi Johari
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Marjan Zare
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| | - Seyed Vahid Hosseini
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
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Russell JBW, Koroma TR, Sesay S, Samura SK, Lakoh S, Bockarie A, Abir OT, Kanu JS, Coker J, Jalloh A, Conteh V, Conteh S, Smith M, Mahdi OZ, Lisk DR. Burden of cardiometabolic risk factors and preclinical target organ damage among adults in Freetown, Sierra Leone: a community-based health-screening survey. BMJ Open 2023; 13:e067643. [PMID: 37192807 DOI: 10.1136/bmjopen-2022-067643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of cardiometabolic risk factors (CMRFs), target organ damage (TOD) and its associated factors among adults in Freetown, Sierra Leone. DESIGN This community-based cross-sectional study used a stratified multistage random sampling method to recruit adult participants. SETTING The health screening study was conducted between October 2019 and October 2021 in Western Area Urban, Sierra Leone. PARTICIPANTS A total of 2394 adult Sierra Leoneans aged 20 years or older were enrolled. OUTCOME MEASURE Anthropometric data, fasting lipid profiles, fasting plasma glucose, TOD, clinical profiles and demographic characteristics of participants were described. The cardiometabolic risks were further related to TOD. RESULTS The prevalence of known CMRFs was 35.3% for hypertension, 8.3% for diabetes mellitus, 21.1% for dyslipidaemia, 10.0% for obesity, 13.4% for smoking and 37.9% for alcohol. Additionally, 16.1% had left ventricular hypertrophy (LVH) by ECG, 14.2% had LVH by two-dimensional echo and 11.4% had chronic kidney disease (CKD). The odds of developing ECG-LVH were higher with diabetes (OR=1.255, 95% CI (0.822 to 1.916) and dyslipidaemia (OR=1.449, 95% CI (0.834 to 2.518). Associated factors for higher odds of Left Ventricular Mass Index by echo were dyslipidaemia (OR=1.844, 95% CI (1.006 to 3.380)) and diabetes mellitus (OR=1.176, 95% CI (0.759 to 1.823)). The odds of having CKD were associated with diabetes mellitus (OR=1.212, 95% CI (0.741 to 1.983)) and hypertension (OR=1.163, 95% CI (0.887 to 1.525)). A low optimal cut-off point for ECG-LVH (male 24.5 mm vs female 27.5 mm) was required to maximise sensitivity and specificity by a receiver operating characteristics curve since the odds for LVH by ECG were low. CONCLUSIONS This study provides novel data-driven information on the burden of CMRF and its association with preclinical TOD in a resource-limited setting. It illustrates the need for interventions in improving cardiometabolic health screening and management in Sierra Leonean.
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Affiliation(s)
- James Baligeh Walter Russell
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Theresa Ruba Koroma
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Santigie Sesay
- Directorate of Non-Communicable Diseases and Mental Health, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Sallieu Kabay Samura
- Department of Mathematics and Statistics, Fourah Bay College, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ansumana Bockarie
- School of Medical Sciences, Department of Internal Medicine, University of Cape Coast, Cape Coast, Ghana
| | - Onome Thomas Abir
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- Department of Community Health, Faculty of Clinical Sciences, College of Medicine & Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joshua Coker
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdul Jalloh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Victor Conteh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sorie Conteh
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Smith
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Othman Z Mahdi
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - Durodami R Lisk
- Department of Internal Medicine, College of Medicine And Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Tekle DY, Rosewarne E, Santos JA, Trieu K, Buse K, Palu A, Thow AM, Jan S, Webster J. Do Food and Nutrition Policies in Ethiopia Support the Prevention of Non-Communicable Diseases through Population-Level Salt Reduction Measures? A Policy Content Analysis. Nutrients 2023; 15:nu15071745. [PMID: 37049585 PMCID: PMC10096844 DOI: 10.3390/nu15071745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Despite the importance of salt reduction to health outcomes, relevant policy adoption in Ethiopia has been slow, and dietary consumption of sodium remains relatively high. Aim: This analysis aims to understand the content and context of existing food-related policy, strategy, and guideline documents to identify gaps and potential opportunities for salt reduction in Ethiopia in the wider context of global evidence-informed best practice nutrition policy. Methods: Policy documents relevant to food and noncommunicable diseases (NCDs), published between 2010 and December 2021, were identified through searches of government websites supplemented with experts’ advice. Documentary analysis was conducted drawing on the ‘policy cube’ which incorporates three dimensions: (i) comprehensiveness of policy measures, which for this study included the extent to which the policy addressed the food-related WHO “Best Buys” for the prevention of NCDs; (ii) policy salience and implementation potential; and (iii) equity (including gender) and human rights orientation. Results: Thirty-two policy documents were retrieved from government ministries, of which 18 were deemed eligible for inclusion. A quarter of these documents address diet-related “Best Buys” through the promotion of healthy nutrition and decreasing consumption of excess sodium, sugar, saturated fat, and trans-fats. The remainder focuses on maternal and child health and micronutrient deficiencies. All documents lack detail relating to budget, monitoring and evaluation, equity, and rights. Conclusions: This review demonstrates that the Government of Ethiopia has established policy frameworks highlighting its intention to address NCDs, but that there is an opportunity to strengthen these frameworks to improve the implementation of salt reduction programs. This includes a more holistic approach, enhanced clarification of implementation responsibilities, stipulation of budgetary allocations, and promoting a greater focus on inequities in exposure to nutrition interventions across population groups. While the analysis has identified gaps in the policy frameworks, further qualitative research is needed to understand why these gaps exist and to identify ways to fill these gaps.
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Affiliation(s)
- Dejen Yemane Tekle
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
- School of Public Health, Mekelle University, Mekelle 1871, Ethiopia
| | - Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Kent Buse
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
- The George Institute for Global Health, Imperial College London, London NW9 7PA, UK
| | - Aliyah Palu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen Jan
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
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Zawdie B, Tesfaye T, Moges SB, Tesfaye Y, Kebede A, Tadesse M, Gudina EK, Dadi LS, Tamiru D, Lemma TB. Metabolic syndrome distributions in dietary diversity score groups and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia: a community based cross- sectional study. BMC Endocr Disord 2022; 22:328. [PMID: 36544146 PMCID: PMC9773519 DOI: 10.1186/s12902-022-01238-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dietary diversity score has long been recognized as a key component of diets quality balances for healthy life status. However, diets with more variety of food items might increase calorie intake and body weight, which, in turn leads to central obesity (waist circumference).Therefore, this study aims to determine the prevalence of metabolic syndrome among dietary diversity score groups, and its associated factors among adults in the urban community of Jimma, Southwest Ethiopia. METHODS A total of 915 adults aged ≥ 18 years were randomly recruited in this cross-sectional study.The study was undertaken from June 17, 2019, up to July 27, 2019. To this end, the collected data were entered to Epi Data 3.1 and analysed using and SPSS 25 version. What's more, a multivariable logistic regression was used to assess associated factors of the unrecognized metabolic syndrome; adjusted odds ratio (AOR) with its corresponding 95% CI, at P-value ≤ 0.05. RESULTS The occurrence of metabolic syndrome was 14.4%, and it is more prevalent in females, 11.15% than males, and 3.25%. The most prevalent components of the metabolic syndrome were low level of high-density lipoprotein, elevated level of triacylglycerol, and waist circumferences. Even though metabolic syndrome is not significantly associated with any of the dietary diversity score groups, its prevalence distribution varies among the groups (6.6% in middle, 5.8% in high and 1.9% in low dietary diversity groups). With potential confounders adjusted, by 75% female was significantly associated with the occurrence of metabolic syndrome than male (102 vs. 29, AOR = 0.25 at 95%CI: 0.15-0.40, P = 0.001). Whereas, age ≥ 35 years old (104 vs. 27, AOR = 2.91 at 95%CI:1.78-4.86,P = 0.001), large family size > 5 (65 vs. 10,AOR = 2.43 95% CI: 1.10-5.36, P = 0.03), overweight and obesity (121 vs. 10, AOR = 6.97, 95% CI: 4.50 -10.83, P = 0.005), elevated total cholesterol (103 vs. 28,AOR = 2.46, 95% CI: 1.47-4.11, P = 0.001), and consuming ( spices, condemns and beverages) ≥ 4 days per week (79 vs. 52, AOR = 0.52, 95% CI:0.33 -0.82, P = 0.005) were positively associated with the prevalence of metabolic syndrome as compared to their counterparts. CONCLUSION Unrecognized metabolic syndrome was relatively high in the study community. The prevalence of metabolic syndrome varied among dietary diversity groups. But any of the dietary diversity scoring categories was not significantly associated with the occurrence of metabolic syndrome. Thus, awareness needs to be made to practice healthy diet and regular physical activity to maintaining normal body weight. Moreover, early screening of metabolic syndrome should be promoted.
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Affiliation(s)
- Belay Zawdie
- Department of Biomedical Sciences, Jimma University, Jimma, Ethiopia
| | - Temamen Tesfaye
- School of Nursing and Midwifery, Jimma University, Jimma, Ethiopia
| | | | - Yonas Tesfaye
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - Ayantu Kebede
- Departments of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Mulualem Tadesse
- Department of Medical Laboratory, Jimma University, Jimma, Ethiopia
| | | | | | - Dessalegn Tamiru
- Department Nutrition and Dietetics, Jimma University, Jimma, Ethiopia
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Screening and Interventions for Cardiovascular Disease Prevention in the Limpopo Province, South Africa: Use of the Community Action Model. Metabolites 2022; 12:metabo12111067. [DOI: 10.3390/metabo12111067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
The rise in non-communicable diseases (NCDs) has been attributed to economic growth in developing countries, shifts in societal norms, and behaviors such as dietary habits and physical activity. Up to 80% of NCDs could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diets, physical inactivity, and the harmful use of alcohol. The South African government’s national strategic plan to control NCDs, which includes cardiovascular disease (CVD) prevention, places a strong emphasis on the need to improve the prevention, detection, early intervention, and management of NCDs. In line with the above recommendations, this study aimed to screen rural communities using the non-laboratory INTERHEART Risk Score tool (NLIRS) and develop relevant and suitable intervention strategies for a patient at moderate risk of developing a heart attack. A quantitative research approach applying a household-based design was used to conduct this study and the community action model (CAM). The difference between pre-intervention and post-intervention results were analyzed using a t-test and Analysis of covariance (ANCOVA) with age, smoke, hypertension, and diabetes as the covariates. The study found a significant difference in proportions between pre and post-intervention for raised Systole (SBP), obesity by body mass index (BMI), and waist circumference (WC). In rural communities, using CAM to improve knowledge and behavioral practices of NCD risk factors is feasible and effective. This basket of interventions will assist community members in reducing their risk of developing metabolic syndromes as well as their risk of developing CVDs. Continued investment and research in CVD prevention interventions are required to improve health, reduce costs, and have long-term benefits for conflict-affected individuals and communities.
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Nsubuga G, Kateete DP, Aloyo SM, Kigingi LN, Emmanuel N, Dafala K, Ntayi ML, Joloba ML, Rogers K. Biobanking in East and Central Africa: A case of the Integrated Biorepository of H3Africa Uganda. OPEN RESEARCH AFRICA 2022; 5:33. [PMID: 37224314 PMCID: PMC10175960 DOI: 10.12688/openresafrica.13495.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 05/26/2023]
Abstract
Biorepositories are essential because they guarantee the proper storage and distribution of biospecimens and their associated data for current and future research. In Eastern and Central Africa, the Integrated Biorepository of H3Africa Uganda (IBRH3AU) at Makerere University in Uganda was the first of its kind. It is strategically located at Makerere University College of Health Sciences, which is home to some of Uganda's most relevant and impactful infectious and non-infectious disease research. Since its inception as a pilot project in 2012, the IBRH3AU biorepository has grown into a state-of-the-art facility serving the H3Africa consortium and the rest of the scientific community. IBRH3AU has built a solid infrastructure over the past ten years with cutting-edge methods and technologies for the collection, processing, quality control, handling, management, storage and shipment of biospecimens. H3Africa researchers, local researchers, postgraduate and postdoctoral students, and the greater scientific community in Eastern and Central Africa and beyond have benefited from IBRH3AU's exceptional biobanking services.
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Affiliation(s)
- Gideon Nsubuga
- Integrated Biorepository of H3Africa Uganda, Makerere University, Kampala, P.O. BOX 7072, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - David Patrick Kateete
- Integrated Biorepository of H3Africa Uganda, Makerere University, Kampala, P.O. BOX 7072, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Sharley Melissa Aloyo
- Integrated Biorepository of H3Africa Uganda, Makerere University, Kampala, P.O. BOX 7072, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Lwanga Newton Kigingi
- Integrated Biorepository of H3Africa Uganda, Makerere University, Kampala, P.O. BOX 7072, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Nasinghe Emmanuel
- Integrated Biorepository of H3Africa Uganda, Makerere University, Kampala, P.O. BOX 7072, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Kezimbira Dafala
- Integrated Biorepository of H3Africa Uganda, Makerere University, Kampala, P.O. BOX 7072, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Moses Levi Ntayi
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Moses L Joloba
- Integrated Biorepository of H3Africa Uganda, Makerere University, Kampala, P.O. BOX 7072, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
| | - Kamulegeya Rogers
- Integrated Biorepository of H3Africa Uganda, Makerere University, Kampala, P.O. BOX 7072, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, P.O. BOX 7072, Uganda
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Moor SE, Tusubira AK, Wood D, Akiteng AR, Galusha D, Tessier-Sherman B, Donroe EH, Ngaruiya C, Rabin TL, Hawley NL, Armstrong-Hough M, Nakirya BD, Nugent R, Kalyesubula R, Nalwadda C, Ssinabulya I, Schwartz JI. Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment. BMJ Open 2022; 12:e059949. [PMID: 35863829 PMCID: PMC9310153 DOI: 10.1136/bmjopen-2021-059949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore how respondents with common chronic conditions-hypertension (HTN) and diabetes mellitus (DM)-make healthcare-seeking decisions. SETTING Three health facilities in Nakaseke District, Uganda. DESIGN Discrete choice experiment (DCE). PARTICIPANTS 496 adults with HTN and/or DM. MAIN OUTCOME MEASURES Willingness to pay for changes in DCE attributes: getting to the facility, interactions with healthcare providers, availability of medicines for condition, patient peer-support groups; and education at the facility. RESULTS Respondents were willing to pay more to attend facilities that offer peer-support groups, friendly healthcare providers with low staff turnover and greater availabilities of medicines. Specifically, we found the average respondent was willing to pay an additional 77 121 Ugandan shillings (UGX) for facilities with peer-support groups over facilities with none; and 49 282 UGX for 1 month of medicine over none, all other things being equal. However, respondents would have to compensated to accept facilities that were further away or offered health education. Specifically, the average respondent would have to be paid 3929 UGX to be willing to accept each additional kilometre they would have to travel to the facilities, all other things being equal. Similarly, the average respondent would have to be paid 60 402 UGX to accept facilities with some health education, all other things being equal. CONCLUSIONS Our findings revealed significant preferences for health facilities based on the availability of medicines, costs of treatment and interactions with healthcare providers. Understanding patient preferences can inform intervention design to optimise healthcare service delivery for patients with HTN and DM in rural Uganda and other low-resource settings.
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Affiliation(s)
- Sarah Eg Moor
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew K Tusubira
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
| | - Dallas Wood
- Center for Applied Economics and Strategy, RTI International, Research Triangle Park, North Carolina, USA
| | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Baylah Tessier-Sherman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Evelyn Hsieh Donroe
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
| | - Christine Ngaruiya
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tracy L Rabin
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
| | - Nicola L Hawley
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mari Armstrong-Hough
- Department of Social and Behavioral Sciences and Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA
| | | | - Rachel Nugent
- Global Non-Communicable Diseases, RTI International, Seattle, Washington, USA
| | - Robert Kalyesubula
- African Community for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
| | - Christine Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
| | - Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
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10
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Rajan V, Terry SF, Green J, Ortega J. Diagnostic Yield and Cost-Benefit When Utilizing Clinical Whole Genome Sequencing. Genet Test Mol Biomarkers 2022; 26:253-254. [PMID: 35593883 DOI: 10.1089/gtmb.2022.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vani Rajan
- Genetic Alliance, Damascus, Maryland, USA
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11
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Bai J, Zhao Y, Yang D, Ma Y, Yu C. Secular trends in chronic respiratory diseases mortality in Brazil, Russia, China, and South Africa: a comparative study across main BRICS countries from 1990 to 2019. BMC Public Health 2022; 22:91. [PMID: 35027030 PMCID: PMC8759233 DOI: 10.1186/s12889-021-12484-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background As the emerging economies, the BRICS (Brazil, Russia, India, China, and South Africa) shared 61.58% of the global chronic respiratory diseases (CRD) deaths in 2017. This study aimed to assess the secular trends in CRD mortality and explore the effects of age, period, and cohort across main BRICS countries. Methods Data were obtained from the Global Burden of Disease Study (GBD) 2019 and analyzed using the age-period-cohort (APC) model to estimate period and cohort effects between 1990 and 2019. The net drifts, local drifts, longitudinal age curves, period/cohort rate ratios (RRs) were obtained through the APC model. Results In 2019, the CRD deaths across the BRICS were 2.39 (95%UI 1.95 to 2.84) million, accounting for 60.07% of global CRD deaths. Chronic obstructive pulmonary disease (COPD) and asthma remained the leading causes of CRD deaths. The age-standardized mortality rates (ASMR) have declined across the BRICS since 1990, with the most apparent decline in China. Meanwhile, the downward trends in CRD death counts were observed in China and Russia. The overall net drifts per year were obvious in China (-5.89%; -6.06% to -5.71%), and the local drift values were all below zero in all age groups for both sexes. The age effect of CRD presented increase with age, and the period and cohort RRs were following downward trends over time across countries. Similar trends were observed in COPD and asthma. The improvement of CRD mortality was the most obvious in China, especially in period and cohort effects. While South Africa showed the most rapid increase with age across all CRD categories, and the period and cohort effects were flat. Conclusions BRICS accounted for a large proportion of CRD deaths, with China and India alone contributing more than half of the global CRD deaths. However, the declines in ASMR and improvements of period and cohort effects have been observed in both sexes and all age groups across main BRICS countries. China stands out for its remarkable reduction in CRD mortality and its experience may help reduce the burden of CRD in developing countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12484-z.
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Affiliation(s)
- Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China
| | - Yudi Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China
| | - Donghui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China
| | - Yudiyang Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185# Donghu Road, 430072, Wuhan, China. .,Global Health Institute, Wuhan University, 185# Donghu Road, 430072, Wuhan, China.
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12
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Houle B, Gaziano TA, Angotti N, Mojola SA, Kabudula CW, Tollman SM, Gómez-Olivé FX. Hypertension incidence among middle-aged and older adults: findings from a 5-year prospective study in rural South Africa, 2010-2015. BMJ Open 2021; 11:e049621. [PMID: 34876423 PMCID: PMC8655592 DOI: 10.1136/bmjopen-2021-049621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES There is a scarcity of longitudinal cohort studies in sub-Saharan Africa to understand the epidemiology of cardiovascular disease as a basis for intervention. We estimated incident hypertension and associated sociodemographic, health and behavioural risk factors in a population aged 40 years and older over a 5-year period. DESIGN We assessed the association between incident hypertension and sociodemographic, health and behavioural factors using Poisson regression. We adjusted for non-response in 2015 using inverse probability sampling weights from a logistic regression including sex and age at baseline. SETTING Rural South Africa. PARTICIPANTS We used a population-based cohort of normotensive adults in 2010 who were aged 40 years and older at retest in 2015. RESULTS Of 676 individuals completing baseline and 5-year follow-up, there were 193 incident cases of hypertension. The overall hypertension incidence rate was 8.374/100 person-years. In multivariable analyses, those who became hypertensive were more likely to be older, have a high waist circumference (incidence rate ratio (IRR): 1.557, 95% CI: 1.074 to 2.259) and be employed (IRR: 1.579, 95% CI: 1.071 to 2.329) at baseline. Being HIV positive and not on antiretroviral therapy at baseline was associated with lower risk of incident hypertension. CONCLUSIONS Over a 5-year period, 29% of respondents developed hypertension. Given the high burden of hypertension in South Africa, continued longitudinal follow-up is needed to understand the complex interplay of non-communicable and infectious diseases and their underlying and modifiable risk factors to inform public health prevention strategies and programmes.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas A Gaziano
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Nicole Angotti
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, American University, Washington, District of Columbia, USA
| | - Sanyu A Mojola
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology, School of Public and International Affairs, and Office of Population Research, Princeton University, Princeton, New Jersey, USA
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Centre for Global Health Research, Umea University, Umea, Sweden
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
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13
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Tindana P, Ramsay M, Klipstein-Grobusch K, Amoakoh-Coleman M. Advancing non-communicable diseases research in Ghana: key stakeholders' recommendations from a symposium. Ghana Med J 2021; 54:121-125. [PMID: 33536683 PMCID: PMC7829050 DOI: 10.4314/gmj.v54i2.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
There has been a growing increase in the prevalence of non-communicable diseases (NCDs) globally with reports suggesting that the fastest increase in NCD deaths in the world will occur in sub-Saharan Africa (SSA) over the next 5 to 15 years. Despite the projected increase in NCD-related deaths, there is little coordinated research in many West African nations, including Ghana, to quantify and study this burden and to translate the research findings into policy and practice. To address these challenges, the Noguchi Memorial Institute for Medical Research and the Navrongo Health Research Centre, both in Ghana, with support from the Wits NCD Research Leadership Training Program organized a two-day symposium to discuss the advancement of NCD research in the West African sub-region. The aim was to propose the way forward for strengthening applied research that can inform the development of health policies and programs focused on NCDs. Participants were drawn from academia, research and health institutions, early career researchers and postdoctoral fellows. We present the key themes that emerged from the symposium and some strategies for advancing NCD research in West Africa. These include interdisciplinary collaboration between NCD researchers in the region, generation of accurate data on disease burden and strengthening stakeholder and public engagement on NCDs.
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Affiliation(s)
- Paulina Tindana
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.,Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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14
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Adeniji F. Burden of out-of-pocket payments among patients with cardiovascular disease in public and private hospitals in Ibadan, South West, Nigeria: a cross-sectional study. BMJ Open 2021; 11:e044044. [PMID: 34103311 PMCID: PMC8190042 DOI: 10.1136/bmjopen-2020-044044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Given that the mechanism for financial protection is underdeveloped in Nigeria, out-of-pocket (OOP) payment for treating cardiovascular disease could impose substantial financial burden on individuals and their families. This study estimated the burden of OOP expenditures incurred by a cohort of patients with cardiovascular disease (CVD) in Ibadan, Nigeria. DESIGN AND SETTINGS This study used a descriptive cross-sectional study design. A standardised survey questionnaire originally developed by Initiative for Cardiovascular Health Research in Developing Countries was used to electronically collect data from all the 744 patients with CVD who accessed healthcare between 4 November 2019 and 31 January 2020 in the cardiology departments of private and public hospitals in Ibadan, Nigeria. Baseline characteristics of respondents were presented using percentages and proportions. The OOP payments were reported as means±SDs. Costs/OOP payments were in Nigerian Naira (NGN). The average US dollar to NGN at the time of data collection was ₦362.12 per $1. All quantitative data were analysed using STATA V.15. OUTCOME MEASURES The burden of outpatient, inpatient and rehabilitative care OOP payments. RESULTS Majority of the patients with CVD were within the age range of 45-74 years and 68.55% of them were women. The diagnostic conditions reported among patients with CVD were hypertensive heart failure (84.01%), dilated cardiomyopathy (4.44%), ischaemic heart disease (3.9%) and anaemic heart failure (2.15%). Across all the hospital facilities, the annual direct and indirect outpatient costs were ₦421 595.7±₦855 962.0 ($1164.2±$2363.8) and ₦19 146.5±₦53 610.1 ($52.87±$148.05). Similarly, the average direct and indirect OOP payments per hospitalisation across all facilities were ₦182 302.4±₦249 090.4 ($503.43±$687.87) and ₦14 700.8±₦ 69 297.1 ($40.60±$191.37), respectively. The average rehabilitative cost after discharge from index hospitalisation was ₦30 012.0 ($82.88). CONCLUSION The burden of OOP payment among patients with CVD is enormous. There is a need to increase efforts to achieve universal health coverage in Nigeria.
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Affiliation(s)
- Folashayo Adeniji
- Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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15
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Bello B, Useh U. COVID-19: Are Non-Communicable Diseases Risk Factors for Its Severity? Am J Health Promot 2021; 35:720-729. [PMID: 33576237 DOI: 10.1177/0890117121990518] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify and describe the mechanisms of lifestyle characteristics-obesity, DM, hypertension and physical inactivity-that may lead to the severity of illness among individuals with COVID-19. DATA SOURCE A scoping review was conducted by searching electronic databases of PubMed and Scopus from December 2019 to August 2020. INCLUSION/EXCLUSION CRITERIA inclusion criteria were studies that explicitly describe the mechanism of COVID-19 in relationship with either hypertension, type 2 diabetes mellitus type 2 (DM), obesity and/or physical inactivity. Studies of epidemiological background, descriptive surveys and interventional studies were excluded. DATA EXTRACTION study characteristics were tabulated according to purpose, type of non-communicable diseases (NCDs), the hypothesis on the mechanism of infestation (MOI) and conclusion. DATA SYNTHESIS NCDs were categorized according to type and hypothesis on mechanisms of infestation. The interplay between COVID-19, type of NCDs and MOI leading to the severity of the disease was appraised. RESULTS Twenty-four (24) studies were identified from 357 unique records. Eight studies postulated the mechanism of infestation and interaction between COVID 19 illness severity and Obesity, while 7 studies described COVID-19 and DM. Five studies highlighted the interaction between COVID-19 and hypertension with 4 studies showing how physical activity restriction suppresses immunity. CONCLUSION The current review, identified and explicitly described the mechanisms of the lifestyle characteristics that may increase the severity of illness among people with COVID-19.
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Affiliation(s)
- Bashir Bello
- Lifestyle Diseases, Faculty of Health, 56405North-West University, Vanderbijlpark, South Africa
| | - Ushotanefe Useh
- Lifestyle Diseases, Faculty of Health, 56405North-West University, Vanderbijlpark, South Africa
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16
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N'guessan BB, Asiamah AD, Arthur NK, Frimpong-Manso S, Amoateng P, Amponsah SK, Kukuia KE, Sarkodie JA, Opuni KFM, Asiedu-Gyekye IJ, Appiah-Opong R. Ethanolic extract of Nymphaea lotus L. (Nymphaeaceae) leaves exhibits in vitro antioxidant, in vivo anti-inflammatory and cytotoxic activities on Jurkat and MCF-7 cancer cell lines. BMC Complement Med Ther 2021; 21:22. [PMID: 33413340 PMCID: PMC7791887 DOI: 10.1186/s12906-020-03195-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 12/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nymphaea lotus L. (N. lotus) is an aquatic plant with anecdotal reports suggesting its use in the traditional management of cancer. However, there is a paucity of data on the antioxidant, anti-inflammatory and cytotoxic properties of N. lotus in relation to its phytochemical and elemental contents. This study aimed at determining the antioxidant, anti-inflammatory and cytotoxic properties of the hydro-ethanolic extract of N. lotus leaves (NLE), and its phenolic, flavonoid and elemental constituents. METHODS The antioxidant property of NLE was determined using total phenolic and flavonoid, DPPH radical scavenging, lipid peroxidation and reducing power assays. The anti-inflammatory activity of NLE (100-250-500 mg/kg), diclofenac and hydrocortisone (positive controls) were determined by paw oedema and skin prick tests in Sprague Dawley rats. Also, the erythrocyte sedimentation rate (ESR) was determined by Westergren method. The macro/micro-elements content was determined by the XRF method. The cytotoxic property of NLE was determined by the MTT assay, on two cancer cell lines (MCF-7 and Jurkat) and compared to a normal cell line (Chang liver). Inhibitory concentrations were determined as IC50 values (±SEM). RESULTS The extract had appreciable levels of phenolic and flavonoids compounds and was two-fold more potent in scavenging DPPH radicals than Butylated hydroxytoluene (BHT). However, NLE was three- and six-fold less potent than ascorbic acid and BHT, respectively, in reducing Fe3+ to Fe2+. The extract was six-fold more potent than gallic acid in inhibiting lipid peroxidation. The extract caused a dose-dependent decrease in rat paw oedema sizes, comparable to diclofenac, and a significant decrease in wheel diameters and ESR. The elemental analysis revealed relevant concentrations of Mg2+, P2+, S2+, K2+, Mn+, Fe+, Cu+, Zn+ and Cd+. The extract exhibited cytotoxic activity on both MCF-7 (IC50 = 155.00 μg/ml) and Jurkat (IC50 = 87.29 μg/ml), with higher selectivity for Jurkat cell line. Interestingly, the extract showed low cytotoxicity to the normal Chang liver cell line (IC50 = 204.20 μg/ml). CONCLUSION N. lotus leaves extract exhibited high antioxidant, anti-inflammatory and cancer-cell-specific cytotoxic properties. These aforementioned activities could be attributed to its phenolic, flavonoid and elemental constituents.
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Affiliation(s)
- Benoit Banga N'guessan
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana.
| | - Adwoa Dede Asiamah
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Nana Kwame Arthur
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Samuel Frimpong-Manso
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Patrick Amoateng
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Seth Kwabena Amponsah
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Kennedy Edem Kukuia
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Joseph Adusei Sarkodie
- Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Kwabena Frimpong-Manso Opuni
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Isaac Julius Asiedu-Gyekye
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana
| | - Regina Appiah-Opong
- Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research (NMIMR), College of Health Sciences, University of Ghana, Accra, Ghana
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17
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Millogo O, Doamba JEO, Sié A, Utzinger J, Vounatsou P. Constructing a malaria-related health service readiness index and assessing its association with child malaria mortality: an analysis of the Burkina Faso 2014 SARA data. BMC Public Health 2021; 21:20. [PMID: 33402160 PMCID: PMC7784320 DOI: 10.1186/s12889-020-09994-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
Background The Service Availability and Readiness Assessment surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso. Methods Data on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was employed to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres. Results Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.5% vs. 0.7%, p < 0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30 and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval: 0.19–0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates. Conclusion Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be placed on improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09994-7.
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Affiliation(s)
- Ourohiré Millogo
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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18
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Uchendu O. Disease mortality audit in a Nigerian tertiary care center. SAHEL MEDICAL JOURNAL 2021. [DOI: 10.4103/smj.smj_51_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Erzse A, Abdool Karim S, Thow AM, Ahaibwe G, Amukugo HJ, Asiki G, Gaogane L, Mukanu MM, Ngoma T, Ruhara CM, Wanjohi MN, Hofman K. The data availability landscape in seven sub-Saharan African countries and its role in strengthening sugar-sweetened beverage taxation. Glob Health Action 2021; 14:1871189. [PMID: 33876702 PMCID: PMC8079050 DOI: 10.1080/16549716.2020.1871189] [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: 07/01/2020] [Accepted: 12/29/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Credible data and indicators are necessary for country-specific evidence to support the design, implementation, monitoring and evaluation of sugar-sweetened beverage (SSB) taxation.Objective: A cross-country analysis was undertaken in seven Sub-Saharan African countries to describe the potential role of available data in strengthening SSB taxation. The objectives were to: document currently available data sources; report on public access; discuss strengths and limitations for use in monitoring SSB taxation; describe policy maker's data needs, and propose improvements in data collection.Methods: The study used a mixed-methods approach involving a secondary data analysis of publicly available documents, and a qualitative exploration of the data needs of policy makers' using primary data. Findings were synthesised and assessed for data strengths and weaknesses, including usability and availability. SSB taxation-related data availability was critically assessed with respect to adequacy in strengthening taxation policy on SSBs.Results: Findings showed a paucity of SSB taxation-related data in all seven countries. National survey data are inadequate regarding the intake of SSBs and household expenditure on SSBs. Fiscal data from SSB tax revenue, value added tax from SSB sales, corporate income tax from SSB companies and SSB custom duty revenues, are lacking. Accurate information on the soft drink industry is not easily accessed.Conclusion: Timely, easily understood, concise, and locally relevant evidence is needed in order to inform policy development on SSBs. The relevant data are drawn from multiple sectors. Cross- sector collaboration is therefore needed. Indicators for SSBs should be developed and included in current data collection tools to ensure monitoring and evaluation for SSB taxation.
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Affiliation(s)
- Agnes Erzse
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Safura Abdool Karim
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, Australia
| | - Gemma Ahaibwe
- Economic Policy Research Centre (EPRC), Makerere University, Makerere, Uganda
| | | | - Gershim Asiki
- African Population and Health Research Center, Health and Systems for Health Unit, Kenya
| | - Lebogang Gaogane
- Boitekanelo College, Department of Health Promotion & Education, University of Botswana, Gaborone, Botswana
| | - Mulenga M. Mukanu
- Health Policy and Management Unit, University of Zambia School of Public Health, Lusaka, Zambia
| | - Twalib Ngoma
- Economic and Social Research Foundation, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Milkah N Wanjohi
- African Population and Health Research Center, Health and Systems for Health Unit, Kenya
| | - Karen Hofman
- Faculty of Health Sciences, SAMRC/Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Johannesburg, South Africa
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20
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Li J, Owusu IK, Geng Q, Folson AA, Zheng Z, Adu-Boakye Y, Dong X, Wu WC, Agyekum F, Fei H, Ayetey H, Deng M, Adomako-Boateng F, Jiang Z, Abubakari BB, Xian Z, Fokuoh FN, Appiah LT, Liu S, Lin C. Cardiometabolic Risk Factors and Preclinical Target Organ Damage Among Adults in Ghana: Findings From a National Study. J Am Heart Assoc 2020; 9:e017492. [PMID: 33283559 PMCID: PMC7955390 DOI: 10.1161/jaha.120.017492] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Although sub‐Saharan Africa has a high prevalence of cardiovascular diseases (CVDs), there remains a lack of systematic and comprehensive assessment of risk factors and early CVD outcomes in adults in sub‐Saharan Africa. Methods and Results Using a stratified multistage random sampling method, we recruited 1106 men and women, aged >18 years, from the general population in Ghana to participate in a national health survey from 2016 to 2017. In Ghanaian adults, the age‐standardized prevalence of known CVD risk factors was 15.1% (95% CI, 12.9%–17.3%) for obesity, 6.8% (95% CI, 5.1%–8.5%) for diabetes mellitus, 26.1% (95% CI, 22.9%–29.4%) for hypertension, and 9.3% (95% CI, 7.1%–11.5%) for hyperuricemia. In addition, 10.1% (95% CI, 7.0%–13.2%) of adults had peripheral artery disease, 8.3% (95% CI, 6.7%–10.0%) had carotid thickening, 4.1% (95% CI, 2.9%–5.2%) had left ventricular hypertrophy, and 2.5% (95% CI, 1.5%–3.4%) had chronic kidney disease. Three CVD risk factors appeared to play prominent roles in the development of target organ damage, including obesity for peripheral artery disease (odds ratio [OR], 2.22; 95% CI, 1.35–3.63), hypertension for carotid thickening (OR, 1.92; 95% CI, 1.22–3.08), and left ventricular hypertrophy (OR, 5.28; 95% CI, 2.55–12.11) and hyperuricemia for chronic kidney disease (OR, 5.49; 95% CI, 2.84–10.65). Conclusions This comprehensive health survey characterized the baseline conditions of a national cohort of adults while confirming the prevalence of CVD risk factors, and early CVD outcomes have reached epidemic proportions in Ghana. The distinct patterns of risk factors in the development of target organ damage present important challenges and opportunities for interventions to improve cardiometabolic health among adults in Ghana.
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Affiliation(s)
- Jie Li
- Global Health Research Center Guangdong Provincial People's HospitalGuangdong Academy of Medical Sciences Guangzhou China.,Department of Epidemiology and Center for Global Cardiometabolic Health School of Public Health Departments of Medicine and Surgery The Warren Alpert School of MedicineBrown University Providence RI
| | - Isaac Kofi Owusu
- Department of Medicine School of Medicine and Dentistry College of Health Sciences Kwame Nkrumah University of Science and Technology Kumasi Ghana.,Department of Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Qingshan Geng
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention Department of Cardiology Guangdong Cardiovascular Institute Guangdong Provincial People's HospitalGuangdong Academy of Medical Sciences Guangzhou China
| | | | - Zhichao Zheng
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention Division of Adult Echocardiography Department of Cardiology Guangdong Cardiovascular Institute Guangdong Provincial People's HospitalGuangdong Academy of Medical Sciences Guangzhou China
| | - Yaw Adu-Boakye
- Department of Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Xinran Dong
- Department of Ophthalmology Guangdong Eye Institute Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou China
| | - Wen-Chih Wu
- Department of Epidemiology and Center for Global Cardiometabolic Health School of Public Health Departments of Medicine and Surgery The Warren Alpert School of MedicineBrown University Providence RI.,Providence VA Medical Health SystemAlpert Medical SchoolBrown University Providence RI
| | - Francis Agyekum
- Department of Medicine Greater Accra Regional Hospital Accra Ghana
| | - Hongwen Fei
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention Division of Adult Echocardiography Department of Cardiology Guangdong Cardiovascular Institute Guangdong Provincial People's HospitalGuangdong Academy of Medical Sciences Guangzhou China
| | - Harold Ayetey
- Department of Internal Medicine and Therapeutics School of Medical Sciences University of Cape Coast Ghana
| | - Mulan Deng
- Department of Epidemiology Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou China
| | - Fred Adomako-Boateng
- Regional Directorate of Health Ghana Health Service Ashanti Region, Kumasi Ghana
| | - Zuxun Jiang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention Division of Adult Echocardiography Department of Cardiology Guangdong Cardiovascular Institute Guangdong Provincial People's HospitalGuangdong Academy of Medical Sciences Guangzhou China
| | | | - Zhao Xian
- Department of Science and Education The Second People's Hospital of Nanhai DistrictGuangdong Provincial People's Hospital's Nanhai Hospital Foshan China
| | | | | | - Simin Liu
- Department of Epidemiology and Center for Global Cardiometabolic Health School of Public Health Departments of Medicine and Surgery The Warren Alpert School of MedicineBrown University Providence RI
| | - Chunying Lin
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention Department of Cardiology Guangdong Cardiovascular Institute Guangdong Provincial People's HospitalGuangdong Academy of Medical Sciences Guangzhou China
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21
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Reddy AS, Tomita A, Paruk S. Depression, anxiety and treatment satisfaction in the parents of children on antiretroviral therapy in South Africa. PSYCHOL HEALTH MED 2020; 26:584-594. [PMID: 33085919 DOI: 10.1080/13548506.2020.1837389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Parents of children living with HIV are at increased risk of emotional distress, with negative implications for both their health outcomes. There is limited data on depression and anxiety symptoms in the biological parents as caregivers of children on antiretroviral therapy (ART) in South Africa. We investigated the prevalence and correlates associated with depressive and anxiety symptoms in 200 biological caregiving parents of children on ART at a public hospital in KwaZulu-Natal Province, South Africa. Data were obtained from the Patient Health Questionnaire (PHQ-9) for depressive symptoms and the Generalized Anxiety Depression (GAD-7) for anxiety symptoms, along with sociodemographic questionnaire. Most of the parent caregivers assessed were female (n = 190, 95%), younger than 40 years (n = 151, 75.5%), single (n = 173, 86.5%), unemployed (n = 156, 78%) and HIV+ (n = 183, 91.9%). Sixty-five (32.5%) parents screened positive for depression, 37 (18.5%) for anxiety and 31 (n = 31, 15.5%) for both disorders (i.e. depression/anxiety comorbidity). There were significant associations between death of a child to HIV (aOR = 4.66, 95% CI: 1.33-16.28) with depression/anxiety comorbidity as well as with treatment dissatisfaction (aOR = 13.98, CI: 2.09-93.66), but not with other socio-demographic factors. The high prevalence of depression and anxiety amongst the parent caregivers of children living with HIV suggests the need for mental health screening and care among parents of children attending pediatric HIV services, and particularly for those with history of children lost to HIV.
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Affiliation(s)
- Aderlee S Reddy
- Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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22
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Orunmuyi AT, Lawal IO, Omofuma OO, Taiwo OJ, Sathekge MM. Underutilisation of nuclear medicine scans at a regional hospital in Nigeria: need for implementation research. Ecancermedicalscience 2020; 14:1093. [PMID: 33014135 PMCID: PMC7498276 DOI: 10.3332/ecancer.2020.1093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Nuclear medicine needs better integration into the Nigerian health system. To understand the relevant public health initiatives that will be required, this study assessed the pattern of nuclear medicine imaging services at the first nuclear medicine centre in Nigeria from January 2010 to December 2018. Methods The data of consecutive nuclear medicine (NM) scans performed between 1st January 2010 and 31st December 2018 at the NM department in a tertiary hospital in Nigeria were extracted from patient records and analysed using SAS version 9.4 (SAS Institute, Cary, NC). The National Cancer Institute’s Joinpoint software and QCIS (QGIS project) were used to estimate imaging trends and geographical spread of patients. Results An average of 486 scans per year was performed during the study period. Patients travelled from 32 of Nigeria’s 36 states, and the majority (65%) travelled more than 100 km to obtain NM scans. Bone scans accounted for 88.1% of the studies. The remainder were renal scintigraphy (7.3%), thyroid scans (2.5%), whole-body iodine scans (1.7%) and others (0.4%). Conclusions NM in Nigeria appears underutilised. Furthermore, the studies to characterise the access gaps and implementation needs will contribute to the design of practical strategies to strengthen NM services in Nigeria.
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Affiliation(s)
- Akintunde T Orunmuyi
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ismaheel O Lawal
- Department of Nuclear Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Omonefe O Omofuma
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, USA
| | - Olalekan J Taiwo
- Department of Geography, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Mike M Sathekge
- Department of Nuclear Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
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23
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Pallangyo P, Misidai N, Komba M, Mkojera Z, Swai HJ, Hemed NR, Mayala H, Bhalia S, Millinga J, Mollel UW, Kusima HL, Chavala E, Joram Z, Abdallah H, Hamisi R, Janabi M. Knowledge of cardiovascular risk factors among caretakers of outpatients attending a tertiary cardiovascular center in Tanzania: a cross-sectional survey. BMC Cardiovasc Disord 2020; 20:364. [PMID: 32778068 PMCID: PMC7418378 DOI: 10.1186/s12872-020-01648-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Health literacy on cardiovascular diseases (CVDs) plays an effective role in preventing or delaying the disease onset as well as in impacting the efficacy of their management. In view of the projected low health literacy in Tanzania, we conducted this cross-sectional survey to assess for CVD risk knowledge and its associated factors among patient escorts. METHODS A total of 1063 caretakers were consecutively enrolled in this cross-sectional study. An adopted questionnaire consisting of 22 statements assessing various CVD risk behaviors was utilized for assessment of knowledge. Logistic regression analyses were performed to assess for factors associated with poor knowledge of CVD risks. RESULTS The mean age was 40.5 years and women predominated (55.7%). Over two-thirds had a body mass index (BMI) ≥25 kg/m2, 18.5% were alcohol drinkers, 3.2% were current smokers, and 47% were physically inactive. The mean score was 78.2 and 80.0% had good knowledge of CVD risks. About 16.3% believed CVDs are diseases of affluence, 17.4% thought CVDs are not preventable, and 56.7% had a perception that CVDs are curable. Low education (OR 2.6, 95%CI 1.9-3.7, p < 0.001), lack of health insurance (OR 1.5, 95%CI 1.1-2.3, p = 0.03), and negative family history of CVD death (OR 2.2, 95%CI 1.4-3.5, p < 0.001), were independently associated with poor CVD knowledge. CONCLUSIONS In conclusion, despite of a good level of CVD knowledge established in this study, a disparity between individual's knowledge and self-care practices is apparent.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Makrina Komba
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Zabella Mkojera
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Happiness J. Swai
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Naairah R. Hemed
- Unit of Research and Training, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Henry Mayala
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Upendo W. Mollel
- Outpatient Department, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Happiness L. Kusima
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Ester Chavala
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
- Outpatient Department, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Ziada Joram
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
- Outpatient Department, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Halifa Abdallah
- Outpatient Department, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Rajabu Hamisi
- Quality Assurance Unit, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P. O Box 65141, Dar es Salaam, Tanzania
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Menyanu E, Baatiema L, Charlton K, Wilson M, Aikins ADG, Russell J. Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction. Curr Dev Nutr 2020; 4:nzaa084. [PMID: 32851200 PMCID: PMC7438700 DOI: 10.1093/cdn/nzaa084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/16/2020] [Accepted: 05/13/2020] [Indexed: 01/29/2023] Open
Abstract
Although population salt reduction is considered a "best buy" in addressing hypertension and cardiovascular disease, Ghana shares a high hypertension burden with a seemingly high salt consumption. This article discusses best practices in reducing population salt intake and provides preliminary data on salt and potassium intake, as well as the process to develop a road map and identification of actions needed to support the development of a strategic national document towards salt reduction in Ghana. In February 2019, a 2-d stakeholder meeting was held with government agencies, researchers, nongovernmental organizations, civil society organizations, and international partners to deliberate on salt reduction strategies and interventions needed in the face of rising hypertension and other noncommunicable diseases (NCDs) in Ghana. Recommendations were developed from the stakeholder meeting and are being considered for inclusion in the revision of Ghana's national NCD policy.
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Affiliation(s)
- Elias Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leonard Baatiema
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Michael Wilson
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ama De-Graft Aikins
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Subramanian S, Gakunga R, Jones MD, Kinyanjui A, Ochieng' E, Gikaara N, Maluni F, Wata D, Korir A, Mutebi M, Ali Z. Establishing Cohorts to Generate the Evidence Base to Reduce the Burden of Breast Cancer in Sub-Saharan Africa: Results From a Feasibility Study in Kenya. J Glob Oncol 2020; 5:1-10. [PMID: 30908145 PMCID: PMC6449073 DOI: 10.1200/jgo.18.00225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE By 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors. METHODS We initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview (at approximately 3 months by telephone). We developed tailored instruments to capture demographics, socioeconomic factors, breast cancer risk, ability to identify breast cancer symptoms, treatments received for breast cancer, and quality of life of survivors. RESULTS We recruited 800 women between the ages of 20 and 60 years and successfully collected baseline data. Completeness of the data was high for demographic variables, but there was a larger proportion of missing information for specific variables required for assessing breast cancer risk. Respondents were able to complete standardized instruments to assess breast cancer knowledge among those without breast cancer and identification of symptoms among survivors. We were able to successfully contact approximately 80% of the participants for follow-up. CONCLUSION This short-term follow-up study provides evidence that women can be successfully tracked and contacted for follow-up in the Kenyan setting and offers lessons to establish future longitudinal cohorts to identify approaches to improve breast cancer outcomes.
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Affiliation(s)
| | | | | | - Asaph Kinyanjui
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | | | - Nancy Gikaara
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | | | - David Wata
- Kenyatta National Hospital, Nairobi, Kenya
| | - Anne Korir
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
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26
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Nyende L, Kalyesubula R, Sekasanvu E, Byakika-Kibwika P. Prevalence of renal dysfunction among HIV infected patients receiving Tenofovir at Mulago: a cross-sectional study. BMC Nephrol 2020; 21:232. [PMID: 32571236 PMCID: PMC7310064 DOI: 10.1186/s12882-020-01873-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing burden of non-communicable disease globally. Tenofovir disoproxil fumarate (TDF) is the most commonly prescribed antiretroviral drug globally. Studies show that patients receiving TDF are more prone to renal dysfunction at some point in time during treatment. Evaluation of kidney function is not routinely done in most HIV public clinics. Identification of renal dysfunction is key in resource constrained settings because managing patients with end stage renal disease is costly. METHOD This was a cross-sectional study conducted at an outpatient clinic in 2018 involving patients on TDF for at least 6 months who were 18 years or older. Patients with documented kidney disease and pregnancy were excluded. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula. Renal dysfunction was defined as any of the following; either eGFR< 60 mL/min/1.73m2,or proteinuria of ≥2+ on urine dipstick, glycosuria with normal blood glucose. Electrolyte abnormalities were also documented. RESULTS We enrolled 278 participants. One hundred sixty nine (60.8%) were females, majority 234(84.2%) were < 50 years old, 205 (73.74%) were in WHO stage 1, most participants 271(97.5%) in addition to TDF were receiving lamivudine/efavirenz. The median age was 37(IQR 29-45) years; median duration on ART was 36 (IQR 24-60) months. The prevalence of renal dysfunction was 2.52% (7/278). Most noted electrolyte abnormality was hypocalcaemia (15.44%). CONCLUSIONS The prevalence of renal dysfunction was low though some participants had hypocalcaemia. Screening for kidney disease should be done in symptomatic HIV infected patients on TDF.
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Affiliation(s)
- Louis Nyende
- KCCA- directorate of public health, P.O. Box 7010, Kampala, Uganda
| | - Robert Kalyesubula
- School of Medicine, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel Sekasanvu
- School of Medicine, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Panorama medical centre, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- School of Medicine, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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27
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Kunutsor SK, Seidu S. Further case for cohort studies of non-communicable diseases in sub-Saharan Africa. Nutr Metab Cardiovasc Dis 2020; 30:1048-1049. [PMID: 32249137 DOI: 10.1016/j.numecd.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK.
| | - Samuel Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4WP, UK
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28
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Ferguson R, Leatherman S, Fiore M, Minnings K, Mosco M, Kaufman J, Kerns E, Amador JJ, Brooks DR, Fiore M, Parekh RS, Fiore L. Prevalence and Risk Factors for CKD in the General Population of Southwestern Nicaragua. J Am Soc Nephrol 2020; 31:1585-1593. [PMID: 32471819 DOI: 10.1681/asn.2019050521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 03/24/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Studies have described Mesoamerican nephropathy among agricultural workers of El Salvador and northwestern Nicaragua. Data on prevalence and risk factors for CKD beyond agricultural workers and in other regions in Nicaragua are sparse. METHODS We recruited participants from 32 randomly selected communities in the Department of Rivas's ten municipalities in two phases. In phase 1, we screened participants using a field-based capillary creatinine measuring system and collected self-reported information on lifestyle and occupational, exposure, and health histories. Two years later, in phase 2, we enrolled 222 new participants, performing serum creatinine testing in these participants and confirmatory serum creatinine testing in phase 1 participants. RESULTS We enrolled 1242 of 1397 adults (89%) living in 533 households (median age 41 years; 43% male). We confirmed CKD (eGFR<60 ml/min per 1.73 m2) in 53 of 1227 (4.3%) evaluable participants. In multivariable testing, risk factors for prevalent CKD included age (odds ratio [OR], 1.92; 95% confidence interval [95% CI], 1.89 to 1.96) and self-reported history of hypertension (OR, 1.95; 95% CI, 1.04 to 3.64), diabetes (OR, 2.88; 95% CI, 1.40 to 5.93), or current or past work in the sugarcane industry (OR 2.92; 95% CI, 1.36 to 6.27). CONCLUSIONS Adjusted CKD prevalence was about 5% with repeat confirmatory testing in southwest Nicaragua, lower than in the northwest region. Risk factors included diabetes, hypertension, and current or prior work in the sugarcane industry but not in other forms of agricultural work. Formal CKD surveillance programs in Nicaragua are needed to assess the overall burden of CKD nationally, with a focus on agricultural workers.
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Affiliation(s)
- Ryan Ferguson
- Boston University, School of Public Health, Boston, Massachusetts
| | - Sarah Leatherman
- Boston Cooperative Studies Program Coordinating Center, Veterans Affairs, Boston Healthcare System, Boston, Massachusetts
| | - Madeline Fiore
- University of Massachusetts, School of Medicine, Worcester, Massachusetts
| | - Kailey Minnings
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Martha Mosco
- New York Presbyterian Hospital, Weill Cornell, New York, New York
| | - James Kaufman
- Division of Nephrology, Veterans Affairs New York Harbor Healthcare System and New York University School of Medicine, New York, New York
| | - Eric Kerns
- Division of Nephrology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Juan Jose Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Rulan S Parekh
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.,Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada
| | - Louis Fiore
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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29
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A mixed methods investigation of emergency communications centre triage in the Government Emergency Medical Services System, Cape Town, South Africa. Afr J Emerg Med 2020; 10:S12-S17. [PMID: 33318896 PMCID: PMC7723918 DOI: 10.1016/j.afjem.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/14/2020] [Accepted: 02/22/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction In order to allocate resources in an effective manner, emergency medical services (EMS) systems use dispatch-based triaging to prioritise patients by acuity. Over-triage, wherein patients are assigned a higher priority level than necessary, can serve as a safety measure. However, it places strain on EMS systems, a problem believed to be experienced by South Africa's Western Cape Government EMS system, with almost half of its calls designated at the highest priority level. To begin improving dispatch within WCG EMS, we aimed to describe the current system by identifying the most common conditions dispatched, and those most perceived to be suffering from over-triage. Methods A multi-methods approach was taken: First, a quantitative chart review was used to analyse all calls assigned a dispatch priority by WCG EMS between December 2016 and November 2017. These descriptive data then informed qualitative focus groups to further investigate emergency medical dispatch (EMD). Three focus groups were conducted, each with a convenience sample of staff from: WCG EMS staff, call takers/dispatchers, and call centre managers. Data were reviewed and coded, after which the lead researcher aggregated coded transcripts and conducted thematic content analysis. Results Seventy-nine condition categories were identified from 649,544 completed patient records for the study period. Non-specific pain accounted for the greatest proportion of dispatched complaints (16.88%), followed by assault with a weapon (10.00%) and respiratory complaints (9.71%). Sixteen WCG EMS personnel took part in focus groups, highlighting challenges of the current EMD system, including time constraints, legal risks, communication, overuse of the system, and lack of training. Chest pain, collapsed/unresponsive patients, and vomiting and diarrhoea were frequently noted to be potentially over-triaged conditions. To improve this, participants suggested trainings, modifications to the electronic EMD system, additional protocols, and public education. Conclusion This study identified where over-triage is possibly occurring in the WCG EMS dispatch system, as well as potential solutions proposed by those working within the system. There are many types of effective emergency medical dispatch (EMD) established within high-income countries’ EMS systems. EMDs are often the first opportunity for the recognition of time-critical conditions. Effective EMDs can improve time-to-care and patient outcomes This study explored potential causes of, and solutions to, over-triage in the WCG EMS dispatch system.
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Dominick L, Midgley N, Swart LM, Sprake D, Deshpande G, Laher I, Joseph D, Teer E, Essop MF. HIV-related cardiovascular diseases: the search for a unifying hypothesis. Am J Physiol Heart Circ Physiol 2020; 318:H731-H746. [PMID: 32083970 DOI: 10.1152/ajpheart.00549.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although the extensive rollout of antiretroviral (ARV) therapy resulted in a longer life expectancy for people living with human immunodeficiency virus (PLHIV), such individuals display a relatively increased occurrence of cardiovascular diseases (CVD). This health challenge stimulated significant research interests in the field, leading to an improved understanding of both lifestyle-related risk factors and the underlying mechanisms of CVD onset in PLHIV. However, despite such progress, the precise role of various risk factors and mechanisms underlying the development of HIV-mediated CVD still remains relatively poorly understood. Therefore, we review CVD onset in PLHIV and focus on 1) the spectrum of cardiovascular complications that typically manifest in such persons and 2) underlying mechanisms that are implicated in this process. Here, the contributions of such factors and modulators and underlying mechanisms are considered in a holistic and integrative manner to generate a unifying hypothesis that includes identification of the core pathways mediating CVD onset. The review focuses on the sub-Saharan African context, as there are relatively high numbers of PLHIV residing within this region, indicating that the greater CVD risk will increasingly threaten the well-being and health of its citizens. It is our opinion that such an approach helps point the way for future research efforts to improve treatment strategies and/or lifestyle-related modifications for PLHIV.
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Affiliation(s)
- Leanne Dominick
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Natasha Midgley
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lisa-Mari Swart
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Devon Sprake
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Gaurang Deshpande
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ismail Laher
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa.,Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danzil Joseph
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eman Teer
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M Faadiel Essop
- Centre for Cardio-metabolic Research in Africa, Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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Etyang AO, Sigilai A, Odipo E, Oyando R, Ong'ayo G, Muthami L, Munge K, Kirui F, Mbui J, Bukania Z, Mwai J, Obala A, Barasa E. Diagnostic Accuracy of Unattended Automated Office Blood Pressure Measurement in Screening for Hypertension in Kenya. Hypertension 2019; 74:1490-1498. [PMID: 31587589 PMCID: PMC7069390 DOI: 10.1161/hypertensionaha.119.13574] [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] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Despite increasing adoption of unattended automated office blood pressure (uAOBP) measurement for determining clinic blood pressure (BP), its diagnostic performance in screening for hypertension in low-income settings has not been determined. We determined the validity of uAOBP in screening for hypertension, using 24-hour ambulatory BP monitoring as the reference standard. We studied a random population sample of 982 Kenyan adults; mean age, 42 years; 60% women; 2% with diabetes mellitus; none taking antihypertensive medications. We calculated sensitivity using 3 different screen positivity cutoffs (≥130/80, ≥135/85, and ≥140/90 mm Hg) and other measures of validity/agreement. Mean 24-hour ambulatory BP monitoring systolic BP was similar to mean uAOBP systolic BP (mean difference, 0.6 mm Hg; 95% CI, −0.6 to 1.9), but the 95% limits of agreement were wide (−39 to 40 mm Hg). Overall discriminatory accuracy of uAOBP was the same (area under receiver operating characteristic curves, 0.66–0.68; 95% CI range, 0.64–0.71) irrespective of uAOBP cutoffs used. Sensitivity of uAOBP displayed an inverse association (P<0.001) with the cutoff selected, progressively decreasing from 67% (95% CI, 62–72) when using a cutoff of ≥130/80 mm Hg to 55% (95% CI, 49–60) at ≥135/85 mm Hg to 44% (95% CI, 39–49) at ≥140/90 mm Hg. Diagnostic performance was significantly better (P<0.001) in overweight and obese individuals (body mass index, >25 kg/m2). No differences in results were present in other subanalyses. uAOBP misclassifies significant proportions of individuals undergoing screening for hypertension in Kenya. Additional studies on how to improve screening strategies in this setting are needed.
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Affiliation(s)
- Anthony O Etyang
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme (A.O.E., A.S., E.O., G.O.)
| | - Antipa Sigilai
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme (A.O.E., A.S., E.O., G.O.)
| | - Emily Odipo
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme (A.O.E., A.S., E.O., G.O.)
| | - Robinson Oyando
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya (R.O., K.M., E.B.)
| | - Gerald Ong'ayo
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme (A.O.E., A.S., E.O., G.O.)
| | - Lawrence Muthami
- Centre for Public Health Research (L.M., Z.B., J.M.), Kenya Medical Research Institute, Nairobi
| | - Kenneth Munge
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya (R.O., K.M., E.B.)
| | - Fredrick Kirui
- Centre for Clinical Research (F.K., J.M.), Kenya Medical Research Institute, Nairobi
| | - Jane Mbui
- Centre for Clinical Research (F.K., J.M.), Kenya Medical Research Institute, Nairobi
| | - Zipporah Bukania
- Centre for Public Health Research (L.M., Z.B., J.M.), Kenya Medical Research Institute, Nairobi
| | - Judy Mwai
- Centre for Public Health Research (L.M., Z.B., J.M.), Kenya Medical Research Institute, Nairobi
| | | | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya (R.O., K.M., E.B.)
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Chisumpa VH, Odimegwu CO, Saikia N. Adult mortality in sub-Saharan Africa: cross-sectional study of causes of death in Zambia. Trop Med Int Health 2019; 24:1208-1220. [PMID: 31420929 DOI: 10.1111/tmi.13302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe the age-sex pattern and socio-economic differentials in causes of death among adults between the ages of 15 and 59 years in Zambia. METHODS Using data from the 2010-2012 Zambia sample vital registration with verbal autopsy survey, we calculated the percentage share of causes of death, the age-/sex cause-specific death ratio and cause-eliminated life expectancy at age 15. RESULTS HIV/AIDS was the leading cause of death across all socio-economic subgroups contributing 40.7% of total deaths during the study period. This was followed by deaths due to injury and accidents (11.2%). Cause-specific death ratios due to HIV/AIDS increased by age and peaked in the 35-39 age group and were higher among females than males. The second-leading cause of death was injuries and accidents for males and tuberculosis for females. The third-leading cause of death was cardiovascular diseases for females and tuberculosis for males. Cause of death patterns varied notably by socio-economic characteristics. Deaths attributable to non-communicable diseases were more evident in adults aged 45-59 years. Eliminating HIV/AIDS in Zambia as a cause of death could raise life expectancy at age 15 by 5.7 years for males and by 6.4 years for females. CONCLUSION HIV/AIDS-related health programmes and interventions should be further supported and strengthened, as they would significantly contribute to the reduction in adult mortality in Zambia.
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Affiliation(s)
- Vesper H Chisumpa
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nandita Saikia
- School of Social Sciences, Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi, India.,International Institute for Applied Systems Analysis, Laxenburg, Austria
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Mudie K, Jin MM, Tan, Kendall L, Addo J, Dos-Santos-Silva I, Quint J, Smeeth L, Cook S, Nitsch D, Natamba B, Gomez-Olive FX, Ako A, Perel P. Non-communicable diseases in sub-Saharan Africa: a scoping review of large cohort studies. J Glob Health 2019; 9:020409. [PMID: 31448113 PMCID: PMC6684871 DOI: 10.7189/jogh.09.020409] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Non-communicable diseases (NCDs) cause a large and growing burden of morbidity and mortality in sub-Saharan Africa. Prospective cohort studies are key to study multiple risk factors and chronic diseases and are crucial to our understanding of the burden, aetiology and prognosis of NCDs in SSA. We aimed to identify the level of research output on NCDs and their risk factors collected by cohorts in SSA. Methods We conducted a scoping review to map the extent of current NCDs research in SSA by identifying studies published after the year 2000 using prospectively collected cohort data on any of the six NCDs (cardiovascular diseases, diabetes, obesity, chronic kidney disease, chronic respiratory diseases, and cancers), ≥1 major risk factor (other than age and sex), set only within SSA, enrolled ≥500 participants, and ≥12 months of follow-up with ≥2 data collection points (or with plans to). We performed a systematic search of databases, a manual search of references lists from included articles and the INDEPTH network website, and study investigators from SSA were contacted for further articles. Results We identified 30 cohort studies from the 101 included articles. Eighteen countries distributed in West, Central, East and Southern Africa, were represented. The majority (27%) set in South Africa. There were three studies including children, twenty with adults, and seven with both. 53% of cohorts were sampled in general populations, 47% in clinical populations, and 1 occupational cohort study. Hypertension (n = 23) was most commonly reported, followed by obesity (n = 16), diabetes (n = 15), CKD (n = 6), COPD (n = 2), cervical cancer (n = 3), and breast cancer (n = 1). The majority (n = 22) reported data on at least one demographic/environmental, lifestyle, or physiological risk factor but these data varied greatly. Conclusions Most studies collected data on a combination of hypertension, diabetes, and obesity and few studies collected data on respiratory diseases and cancer. Although most collected data on different risk factors the methodologies varied greatly. Several methodological limitations were found including low recruitment rate, low retention rate, and lack of validated and standardized data collection. Our results could guide potential collaborations and maximize impact to improve our global understanding of NCDs (and their risk factors) in SSA and also to inform future research, as well as policies.
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Affiliation(s)
- Kathleen Mudie
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Melisa Mei Jin
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Biostatistics, GlaxoSmithKline, Stevenage, UK.,Africa NCD Open Lab, Global Health Catalyst, GlaxoSmithKline, Stevenage, UK.,Population and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK.,MRC/UVRI and LSHTM Uganda Research Unit.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, South Africa
| | - Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Juliet Addo
- Africa NCD Open Lab, Global Health Catalyst, GlaxoSmithKline, Stevenage, UK
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer Quint
- Population and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Cook
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Francesc Xavier Gomez-Olive
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, South Africa
| | - Agbor Ako
- Africa NCD Open Lab, Global Health Catalyst, GlaxoSmithKline, Stevenage, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Namujwiga T, Nakitende I, Kellett J, Opio M, Lumala A. Prognostic performance of ECG abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda. Afr J Emerg Med 2019; 9:64-69. [PMID: 31193807 PMCID: PMC6543076 DOI: 10.1016/j.afjem.2018.12.005] [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: 04/03/2018] [Revised: 09/02/2018] [Accepted: 12/19/2018] [Indexed: 12/03/2022] Open
Abstract
Background There are few reports of electrocardiogram (ECG) findings and their prognostic value in acutely ill patients admitted to low resource hospitals in sub-Saharan Africa. Methods We undertook an observational study of acutely ill medical patients admitted to a low-resource hospital in Uganda. Vital signs were used to calculate the National Early Warning Score (NEWS), and all ECGs were assessed using Tan et al.’s scoring system as described in Clin Cardiol 2009;32:82–86. Results There were 1361 ECGs performed, covering 68% of all acutely ill medical patients admitted to the hospital during the study. The most common ECG abnormality was a prolonged QTc interval (42% of all patients) and left ventricular hypertrophy (13.5%). Compared to the 519 patients (38%) with no Tan score abnormality, the 842 (62%) patients with one or more abnormalities were more likely to die in hospital (OR = 2.82; CI95% = 1.50–5.36) and within 30 days of discharge (OR = 2.46; CI95% = 1.50–4.08). There was no relationship between age and mortality; however, after adjustment by logistic regression, any NEWS ≥1 on admission, a Tan score of ≥1, and male sex all remained clinically significant predictors of both in-hospital and 30-day mortality. Discussion The majority of acutely ill medical patients admitted in a low-resource hospital in sub-Saharan Africa had ECG abnormalities, of which prolonged QTc and left ventricular hypertrophy were most common. Those with any Tan score abnormality were twice as likely to die as those without an abnormality.
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Affiliation(s)
| | | | - John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
- Corresponding author.
| | - Martin Opio
- Department of Medicine, Kitovu Hospital, Masaka, Uganda
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Burden of non-communicable diseases among Syrian refugees: a scoping review. BMC Public Health 2019; 19:637. [PMID: 31126261 PMCID: PMC6534897 DOI: 10.1186/s12889-019-6977-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background The scarcity of evidence-based research on non-communicable diseases (NCDs) among Syrian refugees has hampered efforts to address the high burden of these diseases in host countries. The objective of this study is to examine published research on NCDs among Syrian refugees in order to inform future research, practice, programs, and policy. . Methods Using the scoping review framework proposed by Arksey et al., 17 different databases were searched to identify studies reporting on NCDs among Syrian refugees. The number of relevant documents found was 34, with the earliest going back to 2013—2 years after the beginning of the Syrian conflict. Results The majority of these documents were descriptive in nature and only two studies addressed the effectiveness of interventions in the management of NCDs. No studies investigated the prevention of these diseases. Furthermore, only 7 studies addressed the host community and only one research article, conducted in Lebanon, included subjects from the host community. The increasing number of documents over the past 5 years illustrates a growing interest in studying NCDs among Syrian refugees. Examination of the papers showed high prevalence of NCDs among Syrian refugees as well as unmet healthcare needs. Conclusion The findings of this review highlighted the dire need for further research on the burden of NCDs among Syrian refugees. Future studies should diversify research design to include interventions, address the host community in addition to the refugees, tackle prevention as well as treatment of NCDs, and explore strategies to enhance the resilience of the host country’s health system while ensuring quality of care for NCDs. The increasing momentum for research found in this review presents an opportunity to fill current knowledge gaps, which could result in preventing, controlling and ultimately reducing the burden of NCDs among Syrian refugees and their host communities. Electronic supplementary material The online version of this article (10.1186/s12889-019-6977-9) contains supplementary material, which is available to authorized users.
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Hjort L, Lykke Møller S, Minja D, Msemo O, Nielsen BB, Lund Christensen D, Theander T, Nielsen K, Larsen LG, Grunnet LG, Groop L, Prasad R, Lusingu J, Schmiegelow C, Bygbjerg IC. FOETAL for NCD-FOetal Exposure and Epidemiological Transitions: the role of Anaemia in early Life for Non-Communicable Diseases in later life: a prospective preconception study in rural Tanzania. BMJ Open 2019; 9:e024861. [PMID: 31122967 PMCID: PMC6537995 DOI: 10.1136/bmjopen-2018-024861] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Low-income and middle-income countries such as Tanzania experience a high prevalence of non-communicable diseases (NCDs), including anaemia. Studying if and how anaemia affects growth, placenta development, epigenetic patterns and newborns' risk of NCDs may provide approaches to prevent NCDs. PARTICIPANTS The FOETALforNCD (FOetal Exposure and Epidemiological Transitions: the role of Anaemia in early Life for Non-Communicable Diseases in later life) Study is a population-based preconception, pregnancy and birth cohort study (n=1415, n=538, n=427, respectively), conducted in a rural region of North-East Tanzania. All participants were recruited prior to conception or early in pregnancy and followed throughout pregnancy as well as at birth. Data collection included: maternal blood, screening for NCDs and malaria, ultrasound in each trimester, neonatal anthropometry at birth and at 1 month of age, cord blood, placental and cord biopsies for stereology and epigenetic analyses. FINDINGS TO DATE At preconception, the average age, body mass index and blood pressure of the women were 28 years, 23 kg/m2 and 117/75 mm Hg, respectively. In total, 458 (36.7%) women had anaemia (haemoglobin Hb <12 g/dL) and 34 (3.6%) women were HIV-positive at preconception. During pregnancy 359 (66.7%) women had anaemia of which 85 (15.8%) women had moderate-to-severe anaemia (Hb ≤9 g/dL) and 33 (6.1%) women had severe anaemia (Hb ≤8 g/dL). In total, 185 (34.4%) women were diagnosed with malaria during pregnancy. FUTURE PLANS The project will provide new knowledge on how health, even before conception, might modify the risk of developing NCDs and how to promote better health during pregnancy. The present project ended data collection 1 month after giving birth, but follow-up is continuing through regular monitoring of growth and development and health events according to the National Road Map Strategic Plan in Tanzania. This data will link fetal adverse event to childhood development, and depending on further grant allocation, through a life course follow-up.
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Affiliation(s)
- Line Hjort
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Sofie Lykke Møller
- Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
| | - Daniel Minja
- National Institute for Medical Research, Tanga Research centre, Tanga, United Republic of Tanzania
| | - Omari Msemo
- National Institute for Medical Research, Tanga Research centre, Tanga, United Republic of Tanzania
| | | | - Dirk Lund Christensen
- Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
| | - Thor Theander
- Center for Medical Parasitology, Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Karsten Nielsen
- Department of Histopathology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Louise Groth Grunnet
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
| | - Leif Groop
- Department of Clinical Sciences, Clinical Research Centre, Lunds Universitet, Lund, Sweden
- Finnish Institute of Molecular Medicine, Helsinki University, Helsinki, Finland
| | - Rashmi Prasad
- Department of Clinical Sciences, Clinical Research Centre, Lunds Universitet, Lund, Sweden
| | - John Lusingu
- National Institute for Medical Research, Tanga Research centre, Tanga, United Republic of Tanzania
- Center for Medical Parasitology, Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Christentze Schmiegelow
- Center for Medical Parasitology, Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
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Kalyesubula R, Mutyaba I, Rabin T, Andia-Biraro I, Alupo P, Kimuli I, Nabirye S, Kagimu M, Mayanja-Kizza H, Rastegar A, Kamya MR. Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study. PLoS One 2019; 14:e0216060. [PMID: 31086371 PMCID: PMC6516645 DOI: 10.1371/journal.pone.0216060] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa suffers from a dual burden of infectious and non-communicable diseases. There is limited data on causes and trends of admission and death among patients on the medical wards. Understanding the major drivers of morbidity and mortality would help inform health systems improvements. We determined the causes and trends of admission and mortality among patients admitted to Mulago Hospital, Kampala, Uganda. METHODS AND RESULTS The medical record data base of patients admitted to Mulago Hospital adult medical wards from January 2011 to December 2014 were queried. A detailed history, physical examination and investigations were completed to confirm the diagnosis and identify comorbidities. Any histopathologic diagnoses were made by hematoxylin and eosin tissue staining. We identified the 10 commonest causes of hospitalization, and used Poisson regression to generate annual percentage change to describe the trends in causes of hospitalization. Survival was calculated from the date of admission to the date of death or date of discharge. Cox survival analysis was used to identify factors associate with in-hospital mortality. We used a statistical significance level of p<0.05. A total of 50,624 patients were hospitalized with a median age of 38 (range 13-122) years and 51.7% females. Majority of patients (72%) had an NCD condition as the primary reason for admission. Specific leading causes of morbidity were HIV/AIDS in 30% patients, hypertension in 14%, tuberculosis (TB) in 12%), non-TB pneumonia in11%) and heart failure in 9.3%. There was decline in the proportion of hospitalization due to malaria, TB and pneumonia with an annual percentage change (apc) of -20% to -6% (all p<0.03) with an increase in proportions of admissions due to chronic kidney disease, hypertension, stroke and cancer, with apc 13.4% to 24%(p<0.001). Overall, 8,637(17.1%) died during hospitalization with the highest case fatality rates from non-TB pneumonia (28.8%), TB (27.1%), stroke (26.8%), cancer (26.1%) and HIV/AIDS (25%). HIV-status, age above 50yrs and being male were associated with increased risk of death among patients with infections. CONCLUSION Admissions and case fatality rates for both infectious and non-infectious diseases were high, with declining trends in infectious diseases and a rising trend in NCDs. Health care systems in sub-Saharan region need to prepare to deal with dual burden of disease.
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Affiliation(s)
- Robert Kalyesubula
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Innocent Mutyaba
- Department of Medicine, Uganda Cancer Institute, Kampala, Uganda
| | - Tracy Rabin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patricia Alupo
- Department of Medicine, Makerere Lung Institute, Kampala, Uganda
| | - Ivan Kimuli
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stella Nabirye
- Directorate of Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - Magid Kagimu
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Harriet Mayanja-Kizza
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Asghar Rastegar
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Gakunga R, Ali Z, Korir A, Kinyanjui AW, Ochieng’ E, Gikaara N, Maluni F, Subramanian S. Social determinants and individual health-seeking behaviour among women in Kenya: protocol for a breast cancer cohort feasibility study. BMJ Open 2019; 9:e023171. [PMID: 30782697 PMCID: PMC6352789 DOI: 10.1136/bmjopen-2018-023171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A catastrophic 35% increase in the burden of breast cancer in Kenya has been predicted by 2025. Mitigating this burden is critical, and local research is necessary to generate the evidence to inform policy, public health and medical practice. Most of the knowledge available has been derived from studies in high-income countries that are not directly applicable due to economic, social, cultural and ethnic differences. At the time of writing this paper, we had no knowledge of any longitudinal cohort studies in sub-Saharan Africa of both breast cancer survivors and a matching cohort of women who have never had a diagnosis of cancer. We aim to assess feasibility of cohort studies in Kenya that consider clinical characteristics social determinants and individual health seeking behaviour. METHODS AND ANALYSIS This study aims to inform best practices for initiating a longitudinal cohort study in Kenya. It is a two-pronged, prospective mixed methods study of women with and without a diagnosis of breast cancer with baseline data collection and one follow-up data collection approximately 3 months later by telephone. Quantitative and qualitative data will be collected concurrently, analysed separately and together to enrich understanding of concepts by triangulation. We aim to include 800 women aged 30-60 years: 400 in the survivorship cohort and 400 in the non-cancer cohort. Two focus group discussions from each cohort will be carried out to enhance understanding of concepts and to guide recommendations. ETHICS AND DISSEMINATION Independent ethical approval was obtained from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee and the Research Triangle Institute International. Only consenting participants will be enrolled. Counselling support, debriefing discussions and referrals for formal support services will be available for both participants and research assistants. Findings will be disseminated through publications, websites and presentations.
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Affiliation(s)
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | - Anne Korir
- Kenya Cancer Association, Nairobi, Kenya
| | | | | | - Nancy Gikaara
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
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Schutte AE, Gona PN, Delles C, Uys AS, Burger A, Mels CM, Kruger R, Smith W, Fourie CM, Botha S, Lammertyn L, van Rooyen JM, Gafane-Matemane LF, Mokwatsi GG, Breet Y, Kruger HS, Zyl TV, Pieters M, Zandberg L, Louw R, Moss SJ, Khumalo IP, Huisman HW. The African Prospective study on the Early Detection and Identification of Cardiovascular disease and Hypertension (African-PREDICT): Design, recruitment and initial examination. Eur J Prev Cardiol 2019; 26:458-470. [PMID: 30681377 PMCID: PMC6423686 DOI: 10.1177/2047487318822354] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Globally hypertension is stabilising, but in sub-Saharan Africa the incidence
of hypertension remains on an increase. Although this might be attributed to
poor healthcare and ineffective antihypertensive treatment, there is a
limited understanding of population and individual-specific cardiovascular
pathophysiology – necessary for effective prevention and treatment
strategies in Africa. As there is a lack of longitudinal studies tracking
the early pathophysiological development of hypertension in black
populations, the African-PREDICT study was initiated. The purpose of this
paper is to describe the detailed methodology and baseline cohort profile of
the study. Methods and results From 2013 to 2017, the study included 1202 black (N = 606)
and white (N = 596) men and women (aged 20–30 years) from
South Africa – screened to be healthy and clinic normotensive. At baseline,
and each 5-year follow-up examination, detailed measures of health
behaviours, cardiovascular profile and organ damage are taken. Also,
comprehensive biological sampling for the ‘omics’ and biomarkers is
performed. Overall, the baseline black and white cohort presented with
similar ages, clinic and 24-hour blood pressures, but black adults had lower
socioeconomic status and higher central systolic blood pressure than white
individuals. Conclusions The prospective African-PREDICT study in young black and white adults will
contribute to a clear understanding of early cardiovascular disease
development.
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Affiliation(s)
- Aletta E Schutte
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Philimon N Gona
- 3 Department of Exercise and Health Sciences, University of Massachusetts Boston, USA
| | - Christian Delles
- 4 Institute of Cardiovascular and Medical Sciences (ICAMS), University of Glasgow, UK
| | - Aletta S Uys
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - Adele Burger
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa
| | - Catharina Mc Mels
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Ruan Kruger
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Wayne Smith
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Carla Mt Fourie
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Shani Botha
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Leandi Lammertyn
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Johannes M van Rooyen
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Lebo F Gafane-Matemane
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Gontse G Mokwatsi
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - Yolandi Breet
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
| | - H Salome Kruger
- 2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa.,5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Tertia van Zyl
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Marlien Pieters
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Lizelle Zandberg
- 5 Centre of Excellence for Nutrition, North-West University, South Africa
| | - Roan Louw
- 6 Human Metabolomics, North-West University, South Africa
| | - Sarah J Moss
- 7 Physical activity, Sport and Recreation Research Focus Area, North-West University, South Africa
| | | | - Hugo W Huisman
- 1 Hypertension in Africa Research Team (HART), North-West University, South Africa.,2 South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, South Africa
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Mamudu HM, Subedi P, Alamin AE, Veeranki SP, Owusu D, Poole A, Mbulo L, Ogwell Ouma AE, Oke A. The Progress of Tobacco Control Research in Sub-Saharan Africa in the Past 50 Years: A Systematic Review of the Design and Methods of the Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2732. [PMID: 30518024 PMCID: PMC6313754 DOI: 10.3390/ijerph15122732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 01/25/2023]
Abstract
Over one billion of the world's population are smokers, with increasing tobacco use in low- and middle-income countries. However, information about the methodology of studies on tobacco control is limited. We conducted a literature search to examine and evaluate the methodological designs of published tobacco research in Sub-Saharan Africa (SSA) over the past 50 years. The first phase was completed in 2015 using PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. An additional search was completed in February 2017 using PubMed. Only tobacco/smoking research in SSA countries with human subjects and published in English was selected. Out of 1796 articles, 447 met the inclusion criteria and were from 26 countries, 11 of which had one study each. Over half of the publications were from South Africa and Nigeria. The earliest publication was in 1968 and the highest number of publications was in 2014 (n = 46). The majority of publications used quantitative methods (91.28%) and were cross-sectional (80.98%). The commonest data collection methods were self-administered questionnaires (38.53%), interviews (32.57%), and observation (20.41%). Around half of the studies were among adults and in urban settings. We conclud that SSA remains a "research desert" and needs more investment in tobacco control research and training.
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Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Pooja Subedi
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Ali E Alamin
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Daniel Owusu
- Tobacco Center of Regulatory Science (GSU TCORS), Georgia State University, Atlanta, GA 30340, USA.
| | - Amy Poole
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Lazarous Mbulo
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - A E Ogwell Ouma
- Tobacco Control Division, WHO Regional Office for Africa, P.O.Box 06 Brazzaville, Congo.
| | - Adekunle Oke
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA.
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Sinaga M, Worku M, Yemane T, Tegene E, Wakayo T, Girma T, Lindstrom D, Belachew T. Optimal cut-off for obesity and markers of metabolic syndrome for Ethiopian adults. Nutr J 2018; 17:109. [PMID: 30466421 PMCID: PMC6251157 DOI: 10.1186/s12937-018-0416-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is defined as the presence of central obesity plus any two of the following markers: high triglycerides (> 150 mg/dl), low high density lipoprotein (HDL) cholesterol < 40 mg/dl in men and < 50 mg/dl in women, hypertension (blood pressure > 130/85 mmHg or use of antihypertensive medication), high fasting blood glucose (> 100 mg/dl or use of treatment for diabetes mellitus). Since recently, metabolic syndrome and obesity have become emerging problems of both low and middle income countries, although they have been the leading cause of morbidity and mortality in high income countries for the past decades. It has been indicated that the international anthropometric cut-off for detecting obesity is not appropriate for Ethiopians. This study developed optimal cut off values for anthropometric indicators of obesity and markers of metabolic syndrome for Ethiopian adults to enhance preventive interventions. METHODS A total of 704 employees of Jimma University were randomly selected using their payroll as a sampling frame. Data on socio-demographic, anthropometry, clinical and blood samples were collected from February to April 2015. Receiver Operating Characteristic Curve analyses were used to determine optimal anthropometric cut-off values for obesity and markers of the metabolic syndrome. WHO indicators of obesity based on body fat percent (> 25% for males and > 35% for females) were used as binary classifiers for developing anthropometric cut-offs. Optimal cut-off values were presented using sensitivity, specificity and area under the curve. RESULTS The optimal cut-off for obesity using body mass index was 22.2 k/m2 for males and 24.5 kg/m2 for females. Similarly, the optimal waist circumference cut-off for obesity was 83.7 cm for males and 78.0 cm for females. The cut-off values for detecting obesity using waist to hip ratio and waist to height ratio were: WHR (0.88) and WHtR (0.49) for males, while they were 0.82 and 0.50 for females, respectively. Anthropometric cut-off values for markers of metabolic syndrome were lower compared to the international values. For females, the optimal BMI cut-offs for metabolic syndrome markers ranged from 24.8 kg/m2 (triglycerides) to 26.8 kg/m2 (fasting blood sugar). For WC the optimal cut-off ranged from of 82.1 cm (triglyceride) to 96.0 cm(HDL); while for WHtR the optimal values varied from 0.47(HDL) to 0.56(fasting blood sugar). Likewise, the optimal cut-offs of WHR for markers of metabolic syndrome ranged from 0.78(fasting blood sugar) to 0.89(HDL and blood pressure). For males, the optimal BMI cut-offs for metabolic syndrome markers ranged from 21.0 kg/m2 (HDL) to 23.5 kg/m2 (blood pressure). For WC, the optimal cut-off ranged from 85.3 cm (triglyceride) to 96.0 cm(fasting blood sugar); while for WHtR the optimal values varied from 0.47(BP, FBS and HDL) to 0.53(Triglyceride). Similarly, the optimal cut-offs of WHR form markers of metabolic syndrome ranged from 0.86(blood pressure) to 0.95(fasting blood sugar). CONCLUSION The optimal anthropometric cut-offs for obesity and markers of metabolic syndrome in Ethiopian adults are lower than the international values. The findings imply that the international cut-off for WC, WHtR, WHR and BMI underestimate obesity and metabolic syndrome markers among Ethiopian adults, which should be considered in developing intervention strategies. It is recommended to use the new cut-offs for public health interventions to curb the increasing magnitude of obesity and associated metabolic syndrome and diet related non-communicable diseases in Ethiopia.
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Affiliation(s)
- Makeda Sinaga
- Human Nutrition Unit, Faculty of public Health, Jimma University, PO.BOX: 378, Jimma, Southwest Ethiopia
| | - Meron Worku
- College of Health Sciences, Wolkite University, Welkite, Ethiopia
| | - Tilahun Yemane
- Faculty of Health Sciences, Department of Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene
- Department of Internal Medicine, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Tolassa Wakayo
- Human Nutrition Unit, Faculty of public Health, Jimma University, PO.BOX: 378, Jimma, Southwest Ethiopia
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - David Lindstrom
- Population Studies Centre, Brown University, Providence, USA
| | - Tefera Belachew
- Human Nutrition Unit, Faculty of public Health, Jimma University, PO.BOX: 378, Jimma, Southwest Ethiopia
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Sarrafzadegan N, Hassannejad R, Roohafza H, Sadeghi M, Talaei M, Oveisgharan S, Mansourian M. A 10-year Isfahan cohort on cardiovascular disease as a master plan for a multi-generation non-communicable disease longitudinal study: methodology and challenges. J Hum Hypertens 2018; 33:807-816. [PMID: 30385824 DOI: 10.1038/s41371-018-0126-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/25/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022]
Abstract
A 10-year longitudinal population-based study entitled Isfahan Cohort Study (ICS) was conducted in 2001-2011 with cardiovascular disease (CVD) as the primary outcome. We considered ICS as a master plan for a multi-level non-communicable disease (NCD) study named Isfahan Cohort Study 2 (ICS2). ICS2 is a multi-generation 10-year cohort study with new goals and outcomes that have been started in 2013, recruiting a sub-sample of ICS (n = 1487) and a new recruited sample (n = 1355) aged 35 years and over, all living in urban and rural areas of two counties in central Iran. In addition, 2500 of participant's adult children were selected randomly, as well as 1000 of their grandchildren. The aim of ICS2 is to detect the incidence of some NCDs including CVD, cancers, and diabetes and to identify the impact of their behavioral, metabolic, environmental, and genetic risk factors. In addition, studying lifestyle behaviors in three generations in a hierarchical manner of parents, their children and grandchildren in ICS2 will improve our knowledge on other determinants such as epigenetics of NCDs.
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Affiliation(s)
- Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Razieh Hassannejad
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Talaei
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.,Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Shahram Oveisgharan
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Adebamowo SN, Dareng EO, Famooto AO, Offiong R, Olaniyan O, Obende K, Adebayo A, Ologun S, Alabi B, Achara P, Bakare RA, Odutola M, Olawande O, Okuma J, Odonye G, Adebiyi R, Dakum P, Adebamowo CA. Cohort Profile: African Collaborative Center for Microbiome and Genomics Research's (ACCME's) Human Papillomavirus (HPV) and Cervical Cancer Study. Int J Epidemiol 2018; 46:1745-1745j. [PMID: 28419249 PMCID: PMC5837640 DOI: 10.1093/ije/dyx050] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sally N Adebamowo
- Department of Epidemiology and Public Health.,Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Eileen O Dareng
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ayotunde O Famooto
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Richard Offiong
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital
| | | | - Kayode Obende
- Department of Obstetrics and Gynecology, Garki Hospital Abuja
| | - Amos Adebayo
- Department of Obstetrics and Gynecology, Asokoro District Hospital
| | - Sanni Ologun
- Department of Obstetrics and Gynecology, Kubwa General Hospital Abuja
| | - Bunmi Alabi
- Department of Obstetrics and Gynecology, Wuse General Hospital, Abuja, Nigeria
| | - Peter Achara
- Department of Obstetrics and Gynecology, Federal Medical Center, Keffi, Nigeria
| | - Rasheed A Bakare
- Department of Microbiology, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Michael Odutola
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Oluwatoyosi Olawande
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - James Okuma
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - George Odonye
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Ruxton Adebiyi
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Patrick Dakum
- Office of the Chief Executive Officer, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Clement A Adebamowo
- Department of Epidemiology and Public Health.,Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria.,Institute of Human Virology, University of Maryland, Baltimore, MD, USA
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Osakunor DNM, Sengeh DM, Mutapi F. Coinfections and comorbidities in African health systems: At the interface of infectious and noninfectious diseases. PLoS Negl Trop Dis 2018; 12:e0006711. [PMID: 30235205 PMCID: PMC6147336 DOI: 10.1371/journal.pntd.0006711] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is a disease epidemiological transition occurring in Africa, with increasing incidence of noninfectious diseases, superimposed on a health system historically geared more toward the management of communicable diseases. The persistence and sometimes emergence of new pathogens allows for the occurrence of coinfections and comorbidities due to both infectious and noninfectious diseases. There is therefore a need to rethink and restructure African health systems to successfully address this transition. The historical focus of more health resources on infectious diseases requires revision. We hypothesise that the growing burden of noninfectious diseases may be linked directly and indirectly to or further exacerbated by the existence of neglected tropical diseases (NTDs) and other infectious diseases within the population. Herein, we discuss the health burden of coinfections and comorbidities and the challenges to implementing effective and sustainable healthcare in Africa. We also discuss how existing NTD and infectious disease intervention programs in Africa can be leveraged for noninfectious disease intervention. Furthermore, we explore the potential for new technologies-including artificial intelligence and multiplex approaches-for diagnosis and management of chronic diseases for improved health provision in Africa.
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Affiliation(s)
- Derick Nii Mensah Osakunor
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | | | - Francisca Mutapi
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- National Institute for Health Research, Global Health Research Unit Tackling Infections to Benefit Africa, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
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Houehanou YC, Mizéhoun-Adissoda C, Amidou S, Désormais I, Houénassi M, Preux PM, Marin B, Houinato D, Lacroix P. Feasibility of a cardiovascular cohort in a Sub-Saharan Africa community: preliminary report of the pilot project TAHES (Tanvè Health Study) in Benin. Glob Health Action 2018; 10:1270528. [PMID: 28498739 PMCID: PMC5496170 DOI: 10.1080/16549716.2017.1270528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Faced with the growing burden of cardiovascular disease (CVD) including atherosclerotic in Sub-Saharan Africa (SSA), the development of appropriate prediction tools, based on large cohorts, appears useful for prevention. OBJECTIVE The objective of the pilot project TAHES (Tanvè Health Study) was to explore the feasibility of a large cohort study focused on CVD and risk factors in Benin. METHODS We implemented a prospective cohort over 2 years. The sample consisted of all people aged 25 years or older who had lived for at least the previous 6 months in the villages of Tanvè or Dékanmè. At baseline in February 2015, behaviours and medical histories were recorded using a standardized questionnaire adapted from the WHO Steps instrument; screening questionnaires for angina, claudication, congestive heart failure, and stroke were applied; anthropometric measures and fasting capillary blood glucose were taken. All participants were included in the follow-up phase. Surveillance of target CVD and deaths was implemented through a medical and a community network. RESULTS A total of 1,195 participants were enrolled at baseline; women represented 65.5% and the median age was 39 years. The high participation rate (91.4%), the quality of baseline data, and the functionality of the events surveillance network over 8 months indicated good perspective for the feasibility of a large cohort. We recorded a 3.8% prevalence of daily smoking, 3.6% of harmful use of alcohol, 10.7% of obesity, 25.5% of high blood pressure, and 3.5% of diabetes. Prevalence of angina pectoris (2.7%), intermittent claudication (2.0%), congestive heart failure (0.9%), and stroke survival with motor impairment (3‰) were also recorded. Ten deaths occurred during the first 8 months, all within households; a cardiovascular cause was suspected in four cases. CONCLUSION These preliminary results support the feasibility of establishing a cohort in Benin. It would require technical and resource support.
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Affiliation(s)
- Yessito Corine Houehanou
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,c Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology , University of Abomey-Calavi , Cotonou , Bénin
| | - Carmelle Mizéhoun-Adissoda
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,c Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology , University of Abomey-Calavi , Cotonou , Bénin
| | - Salimanou Amidou
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,c Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology , University of Abomey-Calavi , Cotonou , Bénin
| | - Iléana Désormais
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,d Vascular Medicine Unit , CHU Limoges , Limoges , France
| | | | - Pierre-Marie Preux
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,d Vascular Medicine Unit , CHU Limoges , Limoges , France
| | - Benoit Marin
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,f Functional Unit of Clinical Research and Biostatistics , CHU Limoges , Limoges , France
| | - Dismand Houinato
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,c Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology , University of Abomey-Calavi , Cotonou , Bénin.,g Neurology Unit , CNHU Cotonou , Cotonou , Bénin
| | - Philippe Lacroix
- a U1094, Tropical Neuroepidemiology , INSERM , Limoges , France.,b UMR-S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology , University Limoges , Limoges , France.,d Vascular Medicine Unit , CHU Limoges , Limoges , France
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Adeola HA, Adefuye A, Soyele O, Butali A. The dentist-scientist career pathway in Africa: opportunities and obstacles. KOREAN JOURNAL OF MEDICAL EDUCATION 2018; 30:189-198. [PMID: 30180506 PMCID: PMC6127611 DOI: 10.3946/kjme.2018.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/12/2018] [Accepted: 07/16/2018] [Indexed: 05/14/2023]
Abstract
The future of evidence-based dentistry in developing Africa heavily depends on a sustainable establishment of a vibrant dentist-scientist workforce. A dentist scientist is saddled with the responsibility of carrying out robust cutting edge research projects that are inspired by clinical experience. Currently, there are no pipelines in place to systematically train such dentists, neither are there programs in place to allow trained African dentists choose such a career pathway. A dentist-scientist is a person who studied oral, dental, maxillofacial (or craniofacial) diseases, prevention, and population sciences (obtaining a medical degrees such as bachelor of dental surgery [BDS] or BChD) alone; or in combination with other advanced degrees such as doctor of dental surgery (DDS)/doctor of philosophy (PhD) or BDS/PhD. This situation has resulted in overdependence of African clinical practice on research findings from technologically advanced Western countries and a decline in clinical research capacity building. The career path of a dentist-scientist should involve research along the spectrum of basic biomedical sciences, translational, clinical and public health sciences. There are several factors responsible for the ultra-low count of dentist-scientist in the heterogeneous African communities such as: poor biomedical research infrastructure; lack of funding; absence of structured dentist scientist career pathways; lack of personnel, inter alia. Hence, this review hopes to discuss the opportunities of setting up a dentist-scientist training pathway in Africa (as obtains in most developed world settings), identify opportunities and prospects of developing an African dentist-scientist workforce, and finally discuss the challenges involved.
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Affiliation(s)
- Henry Ademola Adeola
- Department of of Oral and Maxillofacial Pathology, Faculty of Dentistry, University of the Western Cape, Republic of South Africa
- Division of Dermatology, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
| | - Anthonio Adefuye
- Division of Health Sciences Education, Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, Republic of South Africa
| | - Olujide Soyele
- Department of Oral Maxillo-Facial Surgery and Oral Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA, USA
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Universal Health Coverage in Africa: Coinfections and Comorbidities. Trends Parasitol 2018; 34:813-817. [PMID: 30057348 DOI: 10.1016/j.pt.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 11/23/2022]
Abstract
At the 67th session of the World Health Organization (WHO) Regional Committee meeting in August 2017, African health ministers adopted a range of transformational actions intended to strengthen health systems in countries, leading to Universal Health Coverage (UHC). A critical challenge for UHC is the existence of coinfections and noncommunicable diseases (NCDs), characterised by comorbidities.
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Rhyne JM, Mumbauer A, Rheeder P, Hall MN, Genkinger J, Medina-Marino A. The South African Rea Phela Health Study: A randomized controlled trial of communication retention strategies. PLoS One 2018; 13:e0196900. [PMID: 29795579 PMCID: PMC5967788 DOI: 10.1371/journal.pone.0196900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/23/2018] [Indexed: 11/25/2022] Open
Abstract
Epidemiological transitions are occurring throughout Africa. To inform public health programs and policies, longitudinal cohorts investigating non-communicable diseases are needed. However, loss-to-follow up is a major problem. In preparation for a longitudinal study, we conducted a randomized controlled trial to test communication-based retention strategies (message content and delivery methods) among a pilot cohort of South African healthcare workers (n = 1536; median age = 36; women = 1270). Two messaging formats across three delivery modes were tested. Response rates were analyzed by intervention, survey return date and method using chi-square tests and univariate logistic regression. Sixty-seven of 238 (17.4%) control group participants and 238 of 1152 (24.6%) intervention group participants were retained (OR 1.54: CI 1.15–2.07; P = 0.004). Odds of being retained were 1.68 times greater for participants who received regular contact and themed messages compared to control (CI 1.22–2.32; P = 0.001). Neither health status nor clinical condition affected response rates (P>0.05). Time-to-first contact did not impact response rates (P>0.05). Message content and delivery method influenced response rates compared to the control, however no difference was found between intervention groups. Although greater retention is required for valid cohort studies, these findings are the first to quantitatively assess retention factors in Africa.
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Affiliation(s)
- James M. Rhyne
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Foundation for Professional Development, Pretoria, South Africa
| | | | - Paul Rheeder
- Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Megan N. Hall
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Jeanine Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, United States of America
| | - Andrew Medina-Marino
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Foundation for Professional Development, Pretoria, South Africa
- * E-mail:
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Gatsi S, Strange M, Dufton A, Williams P, Addo J. Driving a greater understanding of non-communicable diseases in Africa through collaborative research: the experience of the GSK Africa NCD Open Lab. JOURNAL OF GLOBAL HEALTH REPORTS 2018. [DOI: 10.29392/joghr.2.e2018012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
OBJECTIVE To identify predominant dietary patterns in four African populations and examine their association with obesity. DESIGN Cross-sectional study.Setting/SubjectsWe used data from the Africa/Harvard School of Public Health Partnership for Cohort Research and Training (PaCT) pilot study established to investigate the feasibility of a multi-country longitudinal study of non-communicable chronic disease in sub-Saharan Africa. We applied principal component analysis to dietary intake data collected from an FFQ developed for PaCT to ascertain dietary patterns in Tanzania, South Africa, and peri-urban and rural Uganda. The sample consisted of 444 women and 294 men. RESULTS We identified two dietary patterns: the Mixed Diet pattern characterized by high intakes of unprocessed foods such as vegetables and fresh fish, but also cold cuts and refined grains; and the Processed Diet pattern characterized by high intakes of salad dressing, cold cuts and sweets. Women in the highest tertile of the Processed Diet pattern score were 3·00 times more likely to be overweight (95 % CI 1·66, 5·45; prevalence=74 %) and 4·24 times more likely to be obese (95 % CI 2·23, 8·05; prevalence=44 %) than women in this pattern's lowest tertile (both P<0·0001; prevalence=47 and 14 %, respectively). We found similarly strong associations in men. There was no association between the Mixed Diet pattern and overweight or obesity. CONCLUSIONS We identified two major dietary patterns in several African populations, a Mixed Diet pattern and a Processed Diet pattern. The Processed Diet pattern was associated with obesity.
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