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Verstraeten R, Vos‐Seda AG, Boateng D, Scheuermaier K, Tempelman H, Barth RE, Devillé W, Coutinho RA, Venter F, Grobbee DE, Klipstein‐Grobusch K. No Evidence for an Association of HIV and Antiviral Treatment With Changes in Framingham Cardiovascular Risk Score in the Ndlovu Cohort Study. J Am Heart Assoc 2024; 13:e029637. [PMID: 38214319 PMCID: PMC10926821 DOI: 10.1161/jaha.123.029637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND HIV and antiretroviral therapy (ART) have been associated with increased cardiovascular disease (CVD) risk in high-income countries. The authors studied the longitudinal association between HIV and ART and nonlaboratory Framingham Risk Score (FRS) in a middle-income country. METHODS AND RESULTS This longitudinal analysis of the NCS (Ndlovu Cohort Study), South Africa used baseline to 36-month follow-up data. Demographics, HIV, ART status, and cardiometabolic measures were obtained. FRS was used as a CVD risk measure. Through linear mixed models, FRS trends over time and the association with HIV were studied. Analysis included 1136 participants, with 609 (54%) having HIV, and 495 (81%) taking ART. At baseline, 9.8% of participants had a high FRS. People living with HIV (PLHIV) had a 3.2% lower FRS than HIV-negative participants (P<0.001). FRS increased similarly for both groups over time. Other factors associated with FRS were secondary and higher education (ß value: -0.075, P<0.001; ß value: -0.084, P<0.001) and alcohol consumption (ß value: 0.011, P<0.001). CONCLUSIONS CVD risk increased for all participants over 36 months, suggesting classic risk factors rather than HIV status or ART to be drivers of CVD risk. People living with HIV had a significantly lower FRS than their HIV-negative counterparts, possibly related to HIV itself or a more frequent interaction with healthcare services. No association of HIV and ART with changes in FRS over 36 months was observed, suggesting the need for research using clinical endpoints to elucidate the effects of HIV and ART on CVD risk. Population-based prevention of CVD risk factors in sub-Saharan Africa is warranted, regardless of HIV status.
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Affiliation(s)
- Rita Verstraeten
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- BionamiX, Department of Data Analysis and Mathematical ModellingGhent UniversityGhentBelgium
| | - Alinda G. Vos‐Seda
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- Ezintsha, Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Karine Scheuermaier
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Roos E. Barth
- Department of Infectious DiseaseUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Walter Devillé
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
| | - Roel A. Coutinho
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- PharmAccess FoundationAmsterdamThe Netherlands
| | - Francois Venter
- Ezintsha, Faculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
| | - Kerstin Klipstein‐Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary CareUniversity Medical Center, Utrecht UniversityUtrechtThe Netherlands
- Institute of Tropical Medicine, University of TübingenTübingenGermany
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Okube OT, Kimani ST. Effectiveness of Trans-Theoretical Model-Based Health Education Intervention in the Promotion of Lifestyle Changes among Adults with Metabolic Syndrome: A Randomized Controlled Trial. SAGE Open Nurs 2024; 10:23779608241251658. [PMID: 38737629 PMCID: PMC11084986 DOI: 10.1177/23779608241251658] [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: 10/30/2023] [Revised: 03/30/2024] [Accepted: 04/13/2024] [Indexed: 05/14/2024] Open
Abstract
Background Evidence revealed that, 60% of deaths in the underdeveloped nations are linked to adoption of unhealthy lifestyles. The Trans-theoretical Model (TTM) has been considered a useful interventional approach in smoking cessation, drug addiction and weight control. However, its effectiveness in improving changes in dietary pattern, physical activity and alcohol consumption has not been reported. Purpose The study aimed at evaluating the effectiveness of the TTM-based health education intervention in the promotion of lifestyle changes among adults with metabolic syndrome. Methods This was an experimental design where 352 participants with metabolic syndrome were allocated to intervention and control groups. The participants were randomly assigned to receive either standard CVD care or a TTM stage-based lifestyle modification intervention for 12-months. Lifestyle patterns were assessed at baseline and endpoint. The mean difference of the subtotal TTM concept scores between pre and post intervention was evaluated using paired t-test. The chi-square test of independence was used to detect between group differences in the categorical data. Results Most of the participants were in the pre-action stage of change for their dietary intake patterns and physical activity habits at the baseline assessment with no difference between the groups. The intervention group's total level of change toward adopting a healthy lifestyle was markedly (p < 0.001) improved than the control group at the endpoint. The mean scores for the intervention group's stage of change, self-efficacy, and pros and cons of decisional balance all improved significantly (p < 0.001) from the baseline. The mean scores for the control group's pros and cons of decisional balance and stage of change also considerably (p < 0.05) improved from baseline to the endpoint. Conclusion The TTM- based health education intervention was effective in improving the participants' lifestyles that includes diet and physical activity. Health care providers, particularly nurses should implement TTM staged-matched educational intervention for individuals who are at risk for cardiovascular diseases.
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Affiliation(s)
- Okubatsion Tekeste Okube
- School of Nursing, The Catholic University of Eastern Africa, Nairobi, Kenya
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Samuel T. Kimani
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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Wata D, Ogwu J, Dunford L, Lawson G, Tanna S. Utilizing quantitative dried blood spot analysis to objectively assess adherence to cardiovascular pharmacotherapy among patients at Kenyatta National Hospital, Nairobi, Kenya. PLoS One 2023; 18:e0280137. [PMID: 36662714 PMCID: PMC9858374 DOI: 10.1371/journal.pone.0280137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
The burden of cardiovascular disease (CVD) is rising in Kenya and non-adherence to cardiovascular pharmacotherapy is a growing global public health issue that leads to treatment failure, an increased risk of cardiac events and poor clinical outcomes. This study assessed adherence to selected cardiovascular therapy medications among CVD patients attending outpatient clinics at Kenyatta National Hospital, Kenya by determining drug concentration(s) in patient dried blood spot (DBS) samples. Patients who had been taking one or more of the five commonly prescribed CVD medications (amlodipine, atenolol, atorvastatin, losartan, and valsartan) for at least six months were enrolled. Each patient completed a short questionnaire about their medication history and then provided a finger-prick blood spot sample from which drug concentrations were determined by liquid chromatography-high resolution mass spectrometry analysis. Two hundred and thirty-nine patients (62.3% female) participated in the study. The median number of medications used by patients was 2 (IQR 75%-25% is 3-1). Less than half (117; 49.0%) of patients were adherent to their prescribed CVD pharmacotherapy. Binary regression analysis revealed a significant correlation between non-adherence and the number of medications in the treatment regimen (Odds Ratio (OR) 1.583; 95%CI: 0.949-2.639; P-value = 0.039) and that gender was not an independent predictor of medication adherence (OR 1.233; 95%CI: 0.730-2.083; P-value = 0.216). Valuable information about adherence to each medication in the patient's treatment regimen was obtained using quantitative DBS analysis showing that adherence to CVD medications was not uniform. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence to pharmacotherapies objectively, when combined with hyphenated mass spectrometry analytical techniques. This information can provide physicians with an evidence-based novel approach towards personalization and optimization of CVD pharmacotherapy and implementing interventions in the Kenyan population, thereby improving clinical outcomes.
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Affiliation(s)
- David Wata
- Department of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya
| | - John Ogwu
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Louise Dunford
- Faculty of Health and Life Sciences, Leicester School of Allied Health, De Montfort University, Leicester, United Kingdom
| | - Graham Lawson
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Sangeeta Tanna
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
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Okube OT, Kimani ST, Mirie W. Effect of a Nurse-Led Intervention on Knowledge of the Modifiable Risk Behaviors of Cardiovascular Disease: A Randomized Controlled Trial. SAGE Open Nurs 2023; 9:23779608231201044. [PMID: 37691727 PMCID: PMC10492479 DOI: 10.1177/23779608231201044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/27/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Cardiovascular disease (CVD) has disproportionately burdened the low- and middle-income countries where awareness and detection rates remain very low. Interventions directed to promote the community's awareness of CVD may help reduce the public's exposure to behavioral risk factors. However, the effectiveness of interventions implemented through a nurse on knowledge of the modifiable behavioral risk factors and preventive measures of CVD has not been determined in Kenya. Objective To establish the effect of a nurse-led intervention on knowledge of the modifiable risk behaviors of CVD in adults with metabolic syndrome (MetS) attending a mission-based hospital in Kenya. Methods A two-armed parallel-group randomized controlled trial design was conducted among 352 adults aged 18-64 years with MetS. The participants were recruited from a faith-based hospital in Nairobi, Kenya and randomly allocated to either a nurse-led lifestyle intervention or a control group. The intervention group received a comprehensive health education intervention using the World Health Organization (WHO) guideline recommendations for CVD control and prevention. Individuals in the control group were exposed to the usual CVD care according to hospital protocol. The duration of the intervention was 12 months. The primary outcome measure was a change in levels of knowledge on the modifiable risk factors and preventive measures of CVD. Outcome measures were assessed at baseline and at 15 months postintervention. Pre- and postintervention difference in the level of knowledge between the two groups was determined using the chi-square test of independence. Results The knowledge level of CVD risk factors and preventive measures was very low in both groups at baseline without significant difference. A significant improvement in the level of knowledge on CVD risk factors (78.2% vs. 30.4%, p < .001) and preventive measures (74.4% vs. 29.0%, p < .001) was observed in the intervention group relative to the control at the end-line. Conclusions The nurse-led lifestyle intervention significantly improved participants' level of knowledge on CVD risk factors and preventive measures. It is highly recommended that nurses incorporate routine health education interventions for patients with cardio-metabolic abnormalities.
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Affiliation(s)
- Okubatsion Tekeste Okube
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
- School of Nursing, The Catholic University of Eastern Africa, Nairobi, Kenya
| | - Samuel T. Kimani
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Waithira Mirie
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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Asiki G, Kadengye D, Calvert C, Wamukoya M, Mohamed SF, Ziraba A, Iddi S, Bangha M, Wekesah F, Chikozho C, Price A, Crampin M, Kyobutungi C. Trends and risk factors for non-communicable diseases mortality in Nairobi slums (2008-2017). GLOBAL EPIDEMIOLOGY 2021; 3:100049. [PMID: 34977550 PMCID: PMC8683743 DOI: 10.1016/j.gloepi.2021.100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tracking progress in reaching global targets for reducing premature mortality from non-communicable diseases (NCDs) requires accurately collected population based longitudinal data. However, most African countries lack such data because of weak or non-existent civil registration systems. We used data from the Nairobi Urban Health and Demographic Surveillance System (NUDSS) to estimate NCD mortality trends over time and to explore the determinants of NCD mortality. METHODS Deaths identified in the NUHDSS were followed up with a verbal autopsy to determine the signs and symptoms preceding the death. Causes of death were then assigned using InSilicoVA algorithm. We calculated the rates of NCD mortality in the whole NUHDSS population between 2008 and 2017, looking at how these changed over time. We then merged NCD survey data collected in 2008, which contains information on potential determinants of NCD mortality in a sub-sample of the NUHDSS population, with follow up information from the full NUHDSS including whether any of the participants died of an NCD or non-NCD cause. Poisson regression models were used to identify independent risk factors (broadly categorized as socio-demographic, behavioural and physiological) for NCD mortality, as well as non-NCD mortality. RESULTS In the total NUHDSS population of adults age 18 and over, 23% were assigned an NCD as the most likely cause of death. There was evidence that NCD mortality decreased over the study period, with rates of NCD mortality dropping from 1.32 per 1000 person years in 2008-10 (95% CI: 1.13-1.54) to 0.93 per 1000 person years in 2014-17 (95% CI: 0.80-1.08). Of 5115 individuals who participated in the NCD survey in 2008, 421 died during the follow-up period of which 43% were attributed to NCDs. Increasing age, lower education levels, ever smoking and having high blood pressure were identified as independent determinants of NCD mortality in multivariate analyses. CONCLUSION We found that NCDs account for one-quarter of mortality in Nairobi slums, although we document a reduction in the rate of NCD mortality over time. This may be attributed to increased surveillance and introduction of population-wide NCD interventions and health system improvements from research activities in the slums. To achieve further decline there is a need to strengthen health systems to respond to NCD care and prevention along with addressing social factors such as education.
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Affiliation(s)
- Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
- Department of women's and children's health, Karolinska Institutet, Stockholm, Sweden
| | - Damazo Kadengye
- African Population and Health Research Center, Nairobi, Kenya
| | - Clara Calvert
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Abdhalah Ziraba
- African Population and Health Research Center, Nairobi, Kenya
| | - Samuel Iddi
- African Population and Health Research Center, Nairobi, Kenya
| | - Martin Bangha
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | - Alison Price
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mia Crampin
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mbau L, Fourie JM, Scholtz W, Scarlatescu O, Nel G, Gathecha G. PASCAR and WHF Cardiovascular Diseases Scorecard project. Cardiovasc J Afr 2021; 32:161-167. [PMID: 34297032 PMCID: PMC8756039 DOI: 10.5830/cvja-2021-022] [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: 11/06/2022] Open
Abstract
Data collected for the World Heart Federation's Scorecard project regarding the current state of cardiovascular disease prevention, control and management, along with related non-communicable diseases in Kenya are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the accompanying infographic. Information was collected using open-source data sets from the World Bank, the World Health Organization, the Institute for Health Metrics and Evaluation, the International Diabetes Federation and relevant government publications.
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Affiliation(s)
| | - Jean M Fourie
- Pan-African Society of Cardiology, Cape Town, South Africa
| | - Wihan Scholtz
- Pan-African Society of Cardiology, Cape Town, South Africa.
| | | | - George Nel
- Pan-African Society of Cardiology, Cape Town, South Africa
| | - Gladwell Gathecha
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
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Wekesah FM, Mutua MK, Boateng D, Grobbee DE, Asiki G, Kyobutungi CK, Klipstein-Grobusch K. Comparative performance of pooled cohort equations and Framingham risk scores in cardiovascular disease risk classification in a slum setting in Nairobi Kenya. IJC HEART & VASCULATURE 2020; 28:100521. [PMID: 32373711 PMCID: PMC7191575 DOI: 10.1016/j.ijcha.2020.100521] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/12/2020] [Accepted: 04/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) cause 18 million deaths annually. Low- and middle-income countries (LMICs) account for 80% of the CVD burden, and the burden is expected to grow in the region in the coming years. Screening for and identification of individuals at high risk for CVD in primary care settings can be accomplished using available CVD risk scores. However, few of these scores have been validated/recalibrated for use in sub-Saharan Africa (SSA). METHODS Pooled cohort equations (PCE) and Framingham risk scores for 10-year CVD risk were applied on 1960 men and women aged 40 years and older from the AWI-Gen (Africa, Wits-INDEPTH Partnership for GENomic studies) study 2015. Low, moderate/intermediate or high CVD risk classifications correspond to <10%, 10-20% and >20% chance of developing CVD in 10 years respectively. Agreement between the risk scores was assessed using kappa and correlation coefficients. RESULTS High CVD risk was 10.3% in PCE 2013, 0.4% in PCE 2018, 2.9% in Framingham and 3.6% in Framingham non-laboratory scores. Conversely, low CVD risk was 62.2% in PCE 2013 and 95.6% in PCE 2018, 84.0% and 80.1% in Framingham and Framingham non-laboratory scores, respectively. A moderate agreement existed between the Framingham functions (kappa = 0.64, 95% CI 0.59-0.68, correlation, rs = 0.711). There was no agreement between the PCE 2013 and 2018 functions (kappa = 0.05, 95% CI 0.04-0.06). CONCLUSIONS Newer cohort-based data is necessary to validate and recalibrate existing CVD risk scores in order to develop appropriate functions for use in SSA.
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Affiliation(s)
- Frederick M. Wekesah
- African Population and Health Research Center, Nairobi, Kenya
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, United States
| | - Martin K. Mutua
- African Population and Health Research Center, Nairobi, Kenya
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Kerstin Klipstein-Grobusch
- African Population and Health Research Center, Nairobi, Kenya
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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