Epidemiology of cardiovascular diseases related admissions in a referral hospital in the South West region of Cameroon: A cross-sectional study in sub-Saharan Africa

Investigating the enablers and barriers for hypertension control in Dakar: a qualitative system effectiveness study

OBJECTIVE

Cardiovascular disease is the main cause of death worldwide. The leading risk factor, hypertension, is a major public health issue in Senegal, putting the health system under pressure. This qualitative study aimed to investigate how patients progress along the cascade of care of hypertension screening, diagnosis, treatment and control in Dakar, Senegal, in the context of the CARDIO4Cities initiative-a multisectoral urban population health initiative targeting cardiovascular risk factors in various cities globally.

DESIGN AND SETTING

A qualitative case study in Dakar, Senegal, was conducted to map the cascade of hypertension care and identify enablers and barriers for patient progression across the cascade of care.

PARTICIPANTS AND ANALYSIS

Twelve semistructured interviews were conducted with community and healthcare actors in three districts of the city of Dakar. A systems thinking lens and method, called process mapping, was used to guide the qualitative research and the analysis of the results.

RESULTS

The process analysis delineated four themes as enablers of patient progression: improved management processes in primary care for hypertension; community outreach and engagement; data generation for healthcare provider monitoring of the hypertension cascade of care; and providing access to hypertension screening, monitoring and management tools. Barriers across the cascade were patients' low socio-economic status; trivialisation and denial of the disease; systemic challenges in the health system, such as high healthcare provider turnover; traditional gender roles that influence access to healthcare; and inefficiencies of new tools hindering healthcare provider engagement and workflow integration.

CONCLUSIONS

A wide range of patient, health system and contextual factors were identified as facilitating and hindering the progression of hypertension patients across the cascade of care in Dakar, Senegal. The structural determinants of health and systemic challenges in the health system were highlighted as prominent barriers, suggesting the need for upstream, system-oriented interventions for hypertension care in Dakar.

Redox imbalance driven epigenetic reprogramming and cardiovascular dysfunctions: phytocompounds for prospective epidrugs

BACKGROUND

Cardiovascular diseases (CVDs) are the major contributor to global mortality and are gaining incremental attention following the COVID-19 outbreak. Epigenetic events such as DNA methylation, histone modifications, and non-coding RNAs have a significant impact on the incidence and onset of CVDs. Altered redox status is one of the major causative factors that regulate epigenetic pathways linked to CVDs. Various bioactive phytocompounds used in alternative therapies including Traditional Chinese Medicines (TCM) regulate redox balance and epigenetic phenomena linked to CVDs. Phytocompound-based medications are in the limelight for the development of cost-effective drugs with the least side effects, which will have immense therapeutic applications.

PURPOSE

This review comprehends certain risk factors associated with CVDs and triggered by oxidative stress-driven epigenetic remodelling. Further, it critically evaluates the pharmacological efficacy of phytocompounds as inhibitors of HAT/HDAC and DNMTs as well as miRNAs regulator that lowers the incidence of CVDs, aiming for new candidates as prospective epidrugs.

METHODS

PRISMA flow approach has been adopted for systematic literature review. Different Journals, computational databases, search engines such as Google Scholar, PubMed, Science Direct, Scopus, and ResearchGate were used to collect online information for literature survey. Statistical information collected from the World Health Organization (WHO) site (https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)) and the American Heart Association of Heart Disease and Stroke reported the international and national status of CVDs.

RESULTS

The meta-analysis of various studies is elucidated in the literature, shedding light on major risk factors such as socioeconomic parameters, which contribute highly to redox imbalance, epigenetic modulations, and CVDs. Going forward, redox imbalance driven epigenetic regulations include changes in DNA methylation status, histone modifications and non-coding RNAs expression pattern which further regulates global as well as promoter modification of various transcription factors leading to the onset of CVDs. Further, the role of various bioactive compounds used in herbal medicine, including TCM for redox regulation and epigenetic modifications are discussed. Pharmacological safety doses and different phases of clinical trials of these phytocompounds are elaborated on, which shed light on the acceptance of these phytocompounds as prospective drugs.

CONCLUSION

This review suggests a strong linkage between therapeutic and preventive measures against CVDs by targeting redox imbalance-driven epigenetic reprogramming using phytocompounds as prospective epidrugs. Future in-depth research is required to evaluate the possible molecular mechanisms behind the phytocompound-mediated epigenetic reprogramming and oxidative stress management during CVD progression.

Cardiovascular Risk Factors Among Healthcare Providers at the Bamenda Regional Hospital, Bamenda, Cameroon

Objective This study aimed to assess cardiovascular risk factors (CVRFs) among healthcare professionals (HCPs) practicing at the Bamenda Regional Hospital (BRH) in Bamenda, Cameroon. Methodology This was a hospital-based cross-sectional study involving HCPs practicing at the BRH. Data on lifestyle risk factors were collected across several units and services of the BRH by using a modified Health Improvement Card (HIC). Results A total of 237 participants were included in the final analysis; most were female (59.1%). The mean age of the sample was 30.1 ± 5.8 years. Based on the HIC, most HCPs were in the medium-risk zone (54.0%) for diet; in the high-risk zone for physical activity (68.4%); and in the low-risk zone for tobacco use and alcohol consumption (97.9% and 82.3%, respectively). The risk of developing cardiovascular diseases (CVDs) increases from a low to high-risk level. The mean HIC score was 10.3 ± 1.8 in males), and 10.2 ± 1.7 in females (p=0.781). The age group of 20-30 years had the lowest HIC score, with a mean of 9.9 ± 1.6; those over 40 years had higher HIC scores, with a mean of 11.5 ± 1.4 (p=0.000). When HIC CVRFs were quantified (higher score indicates higher risk), the HIC scores were highest in physicians (11.0 ± 1.8), followed by pharmacists (11.0 ± 1.4) and nurses (10.5 ± 1.7), and lowest in physiotherapists (8.0 ± 1.1) (p=0.000). Regarding socioeconomic status, the mean HIC scores were highest for the upper class (11.5 ± 1.3), followed by the middle (10.0 ± 1.9) and lower classes (10.0 ± 1.7) (p=0.013). Conclusions Most participants were in the low-risk zone for BMI and alcohol and tobacco use; in the moderate-risk zone for healthy diet and blood pressure; and the high-risk zone for physical activity and exercise. Physicians exhibited higher levels of CVRFs compared to other healthcare professionals. Furthermore, high socioeconomic status was associated with a high risk of CVD. Our findings identify opportunities for targeted training and effective interventions to reduce the burden of CVDs among HCPs and beyond and maximize their potential as health educators and influencers with their patients and students.

Regional and Sectorial Distribution of Cardiovascular Risk Factors Among Sub-Saharan Africa Workforce: A Systematic Review

The sub-Saharan African region is currently experiencing an unprecedented cardiovascular disease (CVD) epidemic, with CVD accounting for the highest mortality among adults in the region. Changing demographic profiles, lifestyle choices, and preferences for corporate work are identified as root causes of the CVD epidemic in sub-Saharan Africa (SSA). The primary objective of this study was to determine the prevalence of CV risk factors among different regions, countries, and work sectors in SSA. The secondary objective is to identify the work sector with the highest cluster or aggregate of CV risk factors in SSA. This systematic review reports the prevalence of CV risk factors among corporate workers in SSA between 2010 and 2024. Reputable platforms, such as the Cochrane Library, Google Scholar, PubMed, Medline, and Science Direct, were searched for relevant data. A total of 105 studies involving 76,027 participants from nine countries were analyzed. East Africa, Central Africa, West Africa, and Southern Africa had the highest prevalence of unhealthy diet (100%), physical inactivity (80%), high BMI (76%), and metabolic syndrome (MS) (55%), respectively. Ethiopia and South Africa had the highest prevalence of unhealthy diet (100%) and MS (55%), respectively, while Nigeria had the highest prevalence of both stress (71%) and poor sleep (79%). The healthcare work sector had the highest cluster of CV risk factors and the highest prevalence of unhealthy diet (80%), central obesity (51%), and high total cholesterol (36%); the education sector ranked highest in physical inactivity (75%); the administration sector ranked highest in current tobacco smoking (27%) and dysglycemia (17%); and the finance sector workers had the highest prevalence of stress (62%). The prevalence of most risk factors among the corporate workforce in SSA is high, with significant distribution variation across different regions, countries, and work sectors.

Need for Optimal Screening and Behaviour Change Interventions for Cardiometabolic Diseases in Cameroon

Cardiometabolic diseases (CMDs) are a significant public health burden in Cameroon, driven by lifestyle factors such as poor diet, physical inactivity, and tobacco use. The current response to this growing epidemic is inadequate, with limited screening and insufficient implementation of effective behaviour change interventions. To address this, a multi-pronged approach is crucial. This approach should encompass enhanced screening efforts through the integration of CMD risk factor assessments into routine healthcare visits and the implementation of community-based screening programs. Furthermore, promoting behaviour change interventions is vital, including health education, peer support groups, and training healthcare providers in motivational interviewing techniques. Strengthening healthcare systems is essential, requiring increased government investment in primary healthcare, improving access to quality care, and establishing a robust surveillance system to monitor the burden of CMDs. By implementing these strategies, Cameroon may effectively combat the rising tide of CMDs and improve the overall health and well-being of its population.

Pattern and outcome of the first manifestation of cardiovascular disease among patients with type 2 diabetes mellitus in Cameroon: a cross-sectional study

BACKGROUND

Cardiovascular diseases (CVDs) are the most common cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). There is a paucity of data on the pattern of first manifestation of CVD and the outcome among patients with T2DM in Cameroon.

OBJECTIVES

We aimed to examine the pattern of the first manifestation of CVD and the outcome among patients with T2DM.

METHODS

Between January 2017 and December 2023, files of patients with T2DM hospitalized for the first observed CVD were reviewed. We identified cases of three incident overt clinically manifest CVD complications (acute myocardial infarction [AMI], stroke, and heart failure) in hospitalized T2DM patients. Patients with a previous history of CVD were excluded.

RESULTS

Out of the 1091 patients hospitalized with T2DM, we identified 261(23.9%) patients with clinically overt CVD, of whom 129 (49.4%) were females. The mean age was 63.9 ± 12.1 years and ranged from 15 to 91 years. Women were significantly older compared to men (65.4 ± 11.4 years vs. 62.5 ± 12.6 years; p = 0.042). Hypertension was reported in 201 (77%; 95% CI: 71.4-82) patients. Any form of chronic kidney disease was seen in 15 (5.8%; 95% CI: 3.3-9.3) patients. HIV infection was seen in 5 (1.9%; 95% CI: 0.6-4.4) patients. Stroke was the most common incident clinically overt CVD in 144 (55.2%; 95% CI: 48.9-61.3) patients, followed by heart failure in 105 (40.2%; 95% CI: 34.2-46.5) patients, and Acute MI in 12 (4.6%; 95% CI: 2.4-7.9) patients. The mean length of hospital stay was 9.7 ± 6.6 days. Patients with stroke had a significantly longer hospital stay > 7 days (63% vs. 48.7%, p = 0.021). The in-hospital case fatality was seen in 35 (13.4%; 95% CI: 9.5-18.2) patients.

CONCLUSION

Nearly 1 out of 4 hospitalized patients with T2DM was hospitalized for a first CVD. Stroke and heart failure are the most common initial manifestations of CVD. More than three-quarters of the patients had concomitant hypertension and the in-hospital case fatality was high.

CLINICAL TRIAL NUMBER

Not applicable.

People at Risk of, or with Cardiovascular Diseases' Perspectives and Perceptions of Physiotherapist-Led Health Promotion in Cameroon: A Mixed-Methods Study

Cardiovascular diseases (CVDs) and their risk factors are a major cause of illness and death worldwide, especially in low- and middle-income countries like Cameroon. Physiotherapist-led health promotion (PLHP) has proven effective in improving health and reducing CVD risks. Understanding patient perspectives is crucial for designing effective, context-specific PLHP interventions. This study explored patients' views, experiences, perceived usefulness, acceptability, and preferred methods of PLHP, through a sequential explanatory mixed-methods approach. The quantitative data highlights a significant burden of CVD conditions and risk factors among patients seen in physiotherapy services. Qualitatively, three themes were identified and included: (1) perspectives and experiences of people at risk or with CVDs (pwCVDs) on PLHP; (2) perceived usefulness and acceptability of PLHP; (3) preferred delivery methods of PLHP. Participants reported positive feedback on PLHP and physiotherapy services. Barriers to effective PLHP included high workloads for physiotherapists, limited service access in rural areas, and prohibitive costs. Despite these challenges, participants expressed strong confidence in physiotherapists' competence, though they also called for improved regulation and ongoing professional development. PLHP components, especially physical treatment and dietary advice, were deemed highly useful and acceptable. Patients suggested various delivery methods, including peer support groups, home visits, and mass media interventions. This study highlights the need to improve the scope of practice, competence of physiotherapists, and accessibility of physiotherapy services in Cameroon for pwCVDs. It is necessary to adopt multidisciplinary approaches to achieve better outcomes for risk factors like diabetes and hypertension in context.

Artificial intelligence: transforming cardiovascular healthcare in Africa

BACKGROUND

Cardiovascular diseases (CVDs), a significant global health concern, are responsible for 13% of all deaths particularly in Africa, where they contribute substantially to the global disease burden, taking several millions of lives globally and annually. Despite advancements in healthcare, the burden of CVDs continues to rise steadily. This comprehensive review critically examines the intersection of artificial intelligence (AI) and cardiovascular disease (CVD) management in Africa. Drawing on a diverse gamut of scholarly literature and empirical evidence, the review assesses the prevalence, impact, and challenges of CVDs in the African context.

MAIN BODY

The review highlights the potential of AI technologies to revolutionize CVD care, offering insights into its applications in diagnosis, treatment optimization, and remote patient monitoring. It explores existing literature sourced from databases like PUBMED, Scopus and Google Scholar about the current state of AI implementation in African healthcare systems, which are majorly resource-constrained, discussing successes, limitations, and future prospects. The work includes the prevalence and impact of CVDs in Africa, noting the significant public health burden and economic implications. Current challenges in addressing CVDs are outlined, focusing on resource constraints, healthcare system challenges, and socioeconomic factors. Our review takes a dive into AI's role in healthcare, emphasizing its capabilities in disease diagnosis, treatment optimization, and patient monitoring, and presents current applications and case studies of AI in African cardiovascular healthcare. It also addresses the challenges and limitations of implementing AI in this context, such as inadequate infrastructure, lack of high-quality data, and the need for regulatory frameworks.

CONCLUSION

Our review emphasizes the urgent need for collaborative efforts among policymakers, healthcare providers, and researchers to overcome barriers to AI integration and ensure equitable access to innovative healthcare solutions. By fetching existing research and offering practical recommendations, this review contributes to the academic discourse on AI-driven healthcare interventions in Africa, offering an understanding of the opportunities and challenges in leveraging technology to address pressing public health concerns. It calls for increased research, investment, and collaboration to harness AI's full potential in transforming cardiovascular healthcare in Africa.

A Survey of Practice and Factors Affecting Physiotherapist-Led Health Promotion for People at Risk or with Cardiovascular Disease in Cameroon

BACKGROUND

Cardiovascular diseases (CVDs) and associated risk factors are a growing concern in Cameroon. Physiotherapists (PTs) can play a crucial role in prevention and management. However, the extent of Cameroonian PT involvement in health promotion (HP) activities remains unclear. This study assessed Cameroonian physiotherapists' current HP practices for people at risk of or with CVDs (pwCVDs).

METHODS

A cross-sectional survey was administered online to PTs practising in Cameroon.

RESULTS

Out of 181 PT responses, 95% reported providing a variety of HP activities, including weight management (74%), dietary advice (73%), physical activity (69%), smoking cessation (69%), stress management (61%), and sleep promotion (48%). While PTs were confident in lifestyle assessments, they felt less confident about sleep interventions. Strong beliefs, confidence, team support, and time allocation enhanced HP practice. However, preference for passive modalities, patient adherence issues, organisational challenges, role ambiguity among healthcare providers, inadequate training opportunities, and the absence of established guidelines for CVD prevention negatively affect HP practice.

CONCLUSIONS

These findings highlight the challenges and opportunities for enhancing HP delivery within the physiotherapy profession in Cameroon. The findings are useful for future strategies by clinical practitioners and policy makers to address barriers and leverage facilitators effectively for scaling up HP initiatives in Cameroon.

Patterns and outcomes of cardiovascular disease admissions in the medical wards of the Rivers State University Teaching Hospital, Port Harcourt, Nigeria: A two-year review

Background

Cardiovascular diseases (CVD) are widespread and significantly contribute to global mortality with a rising prevalence in developing countries. The aim of this study was to identify the pattern and outcome of admissions related to cardiovascular diseases within the medical wards at the Rivers State University Teaching Hospital.

Methodology

The study was a retrospective cross-sectional hospital-based study. The records of all patients admitted into the medical wards from January 2021 to December 2022 were extracted to include information on biodata, admitting diagnosis, duration of admission, and patients' outcomes.

Results

Over this 2-year period, a total of 1,540 patients were admitted into the wards and751(48.8%) persons were admitted for CVDs with a mean age of 59.6±15. 1years.The commonest cardiovascular diseases documented included heart failure (HF) and cerebrovascular accident (CVA) which occurred in 251(33.4%) and 311(41.1%) patients respectively. Other CVDs recorded were hypertensive crisis in 163(21.7%), acute coronary syndrome (ACS) in 12(1.6%) and pulmonary embolism (PE) in 6(0.8%) patients. During the study period, 311 deaths were recorded representing 20.2% of all admissions with 146(46.6%) hospital deaths attributed to CVDs, accounting for 19.4% of the total cardiovascular admissions with 125 of these deaths occurring in patients with CVA and HF.

Conclusion

Heart failure and Cerebrovascular accidents emerged as significant contributors to the morbidity and mortality of patients on admission in Rivers State. Policies to incorporate appropriate, preventive and management strategies in the community to reflect this distribution are essential to significantly reduce cardiovascular deaths in our population.

Mendelian randomization combined with multi-omics explores the relationship between heart failure and cancer

Background: Whether there is an association between HF (HF) and cancer has not been conclusively established, and it is not clear whether patients with cancer can share similar hospitalization strategies and outcomes with patients with HF. Methods: Genome-wide association summary statistics were performed using a two-sample Mendelian randomization (MR) method for HF patients and cancer patients from the GWAS directory, with co-localization and Summary Data-Based Mendelian Randomization (SMR) analyses to identify HF-associated genes, and transcriptomic analyses to analyze the roles of these genes in the clinical diagnosis and targeted therapies of multiple cancer types. Results: Two-sample MR analysis showed that increased risk of HF was associated with decreased risk of cervical, brain, breast, colorectal, lung, and skin cancers, and co-localization combined with SMR analysis identified ABO and SURF1 as HF-associated genes, and transcriptomic analyses showed that ABO is a risk factor for HF and a protective factor against cancer, whereas SURF1 is a protective factor against HF and a protective factor against cancer. Conclusion: There was no causal relationship between heart failure and cancers (Cervical, brain, breast, colorectal, lung and skin cancers) risk factors, however there was a trend toward a negative causal relationship between heart failure and cancers (Cervical, brain, breast, colorectal, lung and skin cancers) occurrence.

Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study

BACKGROUND

The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts.

METHODS

This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants' alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg).

RESULTS

Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, P = .006, 95% CI (1.178-2.665)], [RR = 1.772, P = .005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, P = .036, 95% CI (1.043-3.378)], adjusted RR = 1.876, P = .041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 P = .003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, P = .006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, P = .030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, P = .034, 95% CI (1.072-5.738)].

CONCLUSION

Alcohol consumption is significantly related to increase BP regardless of HIV infection.

Use of hospital services by patients with chronic conditions in sub-Saharan Africa: a systematic review and meta-analysis

Objective

To estimate the prevalence of individual chronic conditions and multimorbidity among adults admitted to hospital in countries in sub-Saharan Africa.

Methods

We systematically searched MEDLINE®, Embase®, Global Index Medicus, Global Health and SciELO for publications reporting on patient cohorts recruited between 1 January 2010 and 12 May 2023. We included articles reporting prevalence of pre-specified chronic diseases within unselected acute care services (emergency departments or medical inpatient settings). No language restrictions were applied. We generated prevalence estimates using random-effects meta-analysis alongside 95% confidence intervals, 95% prediction intervals and I2 statistics for heterogeneity. To explore associations with age, sex, country-level income status, geographical region and risk of bias, we conducted pre-specified meta-regression, sub-group and sensitivity analyses.

Findings

Of 6976 identified studies, 61 met the inclusion criteria, comprising data from 20 countries and 376 676 people. None directly reported multimorbidity, but instead reported prevalence for individual conditions. Among medical admissions, the highest prevalence was human immunodeficiency virus infection (36.4%; 95% CI: 31.3-41.8); hypertension (24.4%; 95% CI: 16.7-34.2); diabetes (11.9%; 95% CI: 9.9-14.3); heart failure (8.2%; 95% CI: 5.6-11.9); chronic kidney disease (7.7%; 95% CI: 3.9-14.7); and stroke (6.8%; 95% CI: 4.7-9.6).

Conclusion

Among patients seeking hospital care in sub-Saharan Africa, multimorbidity remains poorly described despite high burdens of individual chronic diseases. Prospective public health studies of multimorbidity burden are needed to generate integrated and context-specific health system interventions that act to maximize patient survival and well-being.

The Pattern of Cardiac Disease Admissions and Outcomes among Medical Admissions in St. Paul Hospital Millennium Medical College: A Retrospective Study

Background

The epidemic of cardiovascular diseases (CVD) is a global phenomenon, and approximately 80% of all cardiovascular-related deaths occur in low and middle-income countries including Ethiopia. The aim of this study was to determine the pattern of cardiac admission and its outcome among the annual medical admissions in Addis Ababa.

Method

This was a retrospective, cross-sectional study to evaluate the pattern of cardiac diseases and outcomes among medical admissions at St Paul Specialized Hospital Millennium Medical College from the 1st of Jan 2020 to the 1st of Jan 2021.

Results

The proportion of cardiac admission was 26% among 1,165 medical admissions. The most common cardiac admission was advanced congestive heart failure (CHF) (74% (224)), followed by hypertensive heart disease (HHD) (48.5%) and valvular heart disease (VHD)(23.5%), respectively. Chronic Rheumatic valvular heart disease (CRVHD) was 91.5% of the total VHD and was significantly higher among rural residents and younger populations (p<0.001). Over 12% of CRVHD patients were complicated with cardio-embolic stroke, constituting one-third of the total annual ischemic stroke admissions. Hypertension ((54%,) (164)) was the leading risk factor and was more common among urban residents (p=0.001). The mean duration of total hospital stay was 18.33 days. In-hospital mortality was 23.8% and was associated with shorter hospital stays (p<0.001). The most common immediate cause of death was sepsis of chest focus with multiorgan failure(27.8%), followed by fatal arrhythmia (20.8%) and brain herniation (15.3%), respectively.

Conclusion

Cardiac diseases are common in the study area causing significant mortality among medical admissions. Therefore, early risk assessment, adequate disease control, and stringent inpatient care should be among the priorities to reduce cardiovascular morbidity and mortality.

Prevention and Treatment of Cardiovascular Diseases with Plant Phytochemicals: A Review

Cardiovascular diseases (CVDs) are the world's leading killers, accounting for 30% deaths. According to the WHO report, CVDs kill 17.9 million people per year, and there will be 22.2 million deaths from CVD in 2030. The death rates rise as people get older. Regarding gender, the death rate of women by CVD (51%) is higher than that of men (42%). To decrease and prevent CVD, most people rely on traditional medicine originating from the plant (phytochemicals) in addition to or in preference to commercially available drugs to recover from their illness. The CVD therapy efficacy of 92 plants, including 15 terrestrial plants, is examined. Some medicinal plants well known to treat CVD are, Daucus carota, Nerium oleander, Amaranthus Viridis, Ginkgo biloba, Terminalia arjuna, Picrorhiza kurroa, Salvia miltiorrhiza, Tinospora cordifolia, Mucuna pruriens, Hydrocotyle asiatica, Bombax ceiba, and Andrographis paniculate. The active phytochemicals found in these plants are flavonoids, polyphenols, plant sterol, plant sulphur compounds, and terpenoids. A general flavonoid mechanism of action is to prevent low-density lipoprotein oxidation, which promotes vasodilatation. Plant sterols prevent CVD by decreasing cholesterol absorption in the blood. Plant sulphur compound also prevent CVD by activation of nuclear factor-erythroid factor 2-related factor 2 (Nrf2) and inhibition of cholesterol synthesis. Quinone decreases the risk of CVD by increasing ATP production in mitochondria while terpenoids by decreasing atherosclerotic lesion in the aortic valve. Although several physiologically active compounds with recognized biological effects have been found in various plants because of the increased prevalence of CVD, appropriate CVD prevention and treatment measures are required. More research is needed to understand the mechanism and specific plants' phytochemicals responsible for treating CVD.

Perceptions on preeclampsia and eclampsia among senior, older women, in rural Southwestern Uganda

Background

Eclampsia is among the leading causes of maternal mortality. It is a serious hypertensive complication of pregnancy and increases the risk of cardiovascular disease in later life. Pregnancy-related hypertension complications predispose to chronic hypertension and premature heart attacks. A significant proportion of women with preeclampsia/eclampsia does not reach the formal healthcare system or arrive too late because of certain traditional or cultural beliefs about the condition. The older, senior women in the community are knowledgeable and play a significant role in decision making regarding where mothers should seek maternal health care. Therefore, the purpose of this study was to explore the perceptions of older and senior women regarding the manifestation of, risk factors and possible causes of preeclampsia/eclampsia.

Methods

We conducted a qualitative study in rural Southwestern Uganda. The key informants were senior, older women including community elders, village health team members and traditional birth attendants who were believed to hold local knowledge and influence on birth and delivery. We purposively selected key informants and data were collected till we reached saturation point. We analyzed data using an inductive thematic approach to identify themes.

Results

We interviewed 20 key informants with four themes identified. The 'causes' theme emerged from the subthemes of confusion with other conditions, spiritual beliefs and high blood pressure. The 'risk factors' theme emerged from the subthemes of oedema-related illnesses, poverty-induced malnutrition, and strained relationships. The 'remedies' theme emerged from the consistent mention of traditional herbal treatment, seek medical help, spiritual healing, emotional healing and corrective nutrition as potential solutions. The theme 'effects of preeclampsia/eclampsia' emerged from the mention of pregnancy complications like premature delivery, child loss, operative delivery like caesarian section delivery as well as death. There was no identifiable local name from the interviews. Women carried several myths regarding the cause and these included little blood, witchcraft, ghost attacks and stress from strained relationships including marital tension. Women were generally aware of the outcomes of eclampsia, mainly that it kills.

Conclusions

Eclampsia is associated with significant myths and misconceptions in this rural community. We recommend interventions to increase awareness and dispel these myths and misconceptions, increase access to antenatal preeclampsia surveillance, and facilitate timely referral for basic maternity care as means for early detection and management of preeclampsia.