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Nduka SO, Emeneka OC, Nduka IJ, Onunkwo JC. Cardiovascular risk screening: a 10-year prediction cross-sectional study in a Nigerian agrarian community. Pan Afr Med J 2024; 47:59. [PMID: 38646134 PMCID: PMC11032074 DOI: 10.11604/pamj.2024.47.59.38486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/12/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction cardiovascular disease (CVD) is a major public health issue with a high global death rate and a significant death contribution from low-and middle-income countries. Modifiable and non-modifiable risk factors assessment and screening are important in their effective prevention and control. This study was designed to screen and assess cardiovascular risk factors in an agrarian community in Nigeria and to predict their 10-year CVD risk. Methods this was a cross-sectional study carried out in the Umueri community in Anambra State, Nigeria. Each participant responded to an epidemiologic survey using the World Health Organization (WHO) cardiovascular risk factors assessment tool with point-of-care screening procedures. The risk assessment for 10-year CV risk was conducted using region-specific WHO/ISH charts. Patients´ characteristics were analyzed and presented in frequencies and percentages. Results the mean age, systolic blood pressure, fasting plasma glucose, and total cholesterol of the study population were 54 years ± 1.27, 132 mmHg ± 2.088, 130 mg/dl ± 4.608, and 215 mg/dl ± 10.355 respectively. However, 98 (48.8%) have never had their blood pressure checked. About a quarter of the population had a high predicted risk of developing CVD within 10 years. Conclusion most of the assessed cardiovascular risk factors in the community are on average above the normal ranges and their probability risk of developing CVD within the next 10 years is high.
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Affiliation(s)
- Sunday Odunke Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Obinna Chris Emeneka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Ifeoma Jovita Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Jude Chinedu Onunkwo
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
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García MF, Hessel P, Rodríguez-lesmes P. Wealth and inequality gradients for the detection and control of hypertension in older individuals in middle-income economies around 2007-2015. PLoS One 2022; 17:e0269118. [PMID: 35802577 PMCID: PMC9269405 DOI: 10.1371/journal.pone.0269118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/15/2022] [Indexed: 11/23/2022] Open
Abstract
Socioeconomic inequalities in the detection and treatment of non-communicable diseases represent a challenge for healthcare systems in middle-income countries (MICs) in the context of population ageing. This challenge is particularly pressing regarding hypertension due to its increasing prevalence among older individuals in MICs, especially among those with lower socioeconomic status (SES). Using comparative data for China, Colombia, Ghana, India, Mexico, Russia and South Africa, we systematically assess the association between SES, measured in the form of a wealth index, and hypertension detection and control around the years 2007-15. Furthermore, we determine what observable factors, such as socio-demographic and health characteristics, explain existing SES-related inequalities in hypertension detection and control using a Blinder-Oaxaca decomposition. Results show that the prevalence of undetected hypertension is significantly associated with lower SES. For uncontrolled hypertension, there is evidence of a significant gradient in three of the six countries at the time the data were collected. Differences between rural and urban areas as well as lower and higher educated individuals account for the largest proportion of SES-inequalities in hypertension detection and control at the time. Improved access to primary healthcare in MICs since then may have contributed to a reduction in health inequalities in detection and treatment of hypertension. However, whether this indeed has been the case remains to be investigated.
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Cavagna P, Kramoh KE, Diop IB, Kouam Kouam C, Ikama MS, Takombe JL, Damorou JM, Ali Toure I, Balde DM, Dzudie A, Khoury S, Perier MC, Asselin A, Azizi M, Houenassi MD, Kane A, Kimbally-Kaki SG, Kingue S, Limbole E, Mfeukeu Kuate L, Mipinda JB, Ferreira B, Nhavoto C, Sidy Ali A, Empana JP, N'guetta R, Jouven X, Antignac M. Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study. J Hypertens 2022; 40:1411-20. [PMID: 35762480 DOI: 10.1097/HJH.0000000000003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa. METHODS We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies. RESULTS The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11-1.77)], complication of hypertension [OR 2.4 (1.89-3.03)], former hypertension [OR 3.12 (2.3-4.26)], good adherence [OR 1.98 (1.47-2.66)], from MIC [OR 1.38 (1.10-1.74)] and living in urban areas [OR 1.52 (1.16-1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC. CONCLUSION In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.
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Tesfay FH, Backholer K, Zorbas C, Bowe SJ, Alston L, Bennett CM. The Magnitude of NCD Risk Factors in Ethiopia: Meta-Analysis and Systematic Review of Evidence. Int J Environ Res Public Health 2022; 19:ijerph19095316. [PMID: 35564716 PMCID: PMC9106049 DOI: 10.3390/ijerph19095316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Background: Non-communicable Diseases (NCDs) and their risk factors are the leading contributors to morbidity and mortality globally, particularly in low- and middle-income countries including Ethiopia. To date, there has been no synthesis of the literature on the relative prevalence of NCD risk factors in Ethiopia. Methodology: We conducted a systematic review and meta-analysis of primary studies reporting on the prevalence of NCD risk factors in Ethiopia published in English from 2012 to July 2020. Pre-tested NCD search terms were applied to Medline, Embase, Scopus, CINAHL, and Global Health. Three reviewers screened and appraised the quality of the identified papers. Data extraction was conducted using a pilot tested proforma. Meta-analysis was conducted using Stata 16 and pooled prevalence estimated with associated 95% confidence intervals. Clinically heterogeneous studies that did not fulfil the eligibility criteria for meta-analysis were narratively synthesised. I2 was used to assess statistical heterogeneity. Results: 47 studies fulfilled the inclusion criteria and contributed 68 NCD risk factor prevalence estimates. Hypertension was the most frequently examined NCD risk factor, with a pooled prevalence of 21% (n = 27 studies). The pooled prevalence percentages for overweight and obesity were 19.2% and 10.3%, respectively (n = 7 studies each), with a combined prevalence of 26.8% (n = 1 study). It was not possible to pool the prevalence of alcohol consumption, smoking, metabolic disorders, or fruit consumption because of heterogeneity across studies. The prevalence of alcohol use, as reported from the included individual studies, ranged from 12.4% to 13.5% (n = 7 studies). More than 90% of participants met the WHO-recommended level of physical activity (n = 5 studies). The prevalence of smoking was highly variable, ranging between 0.8% and 38.6%, as was the prevalence of heavy alcohol drinking (12.4% to 21.1%, n = 6 studies) and metabolic syndrome (4.8% to 9.6%, n = 5 studies). Fruit consumption ranged from 1.5% up to the recommended level, but varied across geographic areas (n = 3 studies). Conclusion and recommendations: The prevalence of NCD risk factors in Ethiopia is relatively high. National NCD risk factor surveillance is required to inform the prioritisation of policies and interventions to reduce the NCD burden in Ethiopia.
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Affiliation(s)
- Fisaha Haile Tesfay
- Institute for Health Transformation, Deakin University, Geelong 3220, Australia; (K.B.); (C.Z.); (L.A.); (C.M.B.)
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
- College of Medicine and Health Sciences, School of Public Health, Mekelle University, Mekelle P.O. Box 231, Ethiopia
- Correspondence:
| | - Kathryn Backholer
- Institute for Health Transformation, Deakin University, Geelong 3220, Australia; (K.B.); (C.Z.); (L.A.); (C.M.B.)
| | - Christina Zorbas
- Institute for Health Transformation, Deakin University, Geelong 3220, Australia; (K.B.); (C.Z.); (L.A.); (C.M.B.)
| | - Steven J. Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Geelong 3220, Australia;
| | - Laura Alston
- Institute for Health Transformation, Deakin University, Geelong 3220, Australia; (K.B.); (C.Z.); (L.A.); (C.M.B.)
| | - Catherine M. Bennett
- Institute for Health Transformation, Deakin University, Geelong 3220, Australia; (K.B.); (C.Z.); (L.A.); (C.M.B.)
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Hopp LJ, Clementinah A, Verdick CJ, Napyo A. Annual burden of disease in Nakaale, Karamoja: A descriptive, cross-sectional study. PLOS Glob Public Health 2022; 2:e0000222. [PMID: 36962152 PMCID: PMC10021429 DOI: 10.1371/journal.pgph.0000222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022]
Abstract
Even with global Sustainable Development Goals aimed at reducing poverty by reaching those furthest behind first and reducing inequalities within countries, regions like Karamoja continue to score low on many health indices. To understand the Karamoja context, we aimed to systematically describe the burden of disease in Nakaale, which is a hard-to-reach parish in Nakapiripirit District, through disaggregated data. This descriptive, cross-sectional study was conducted between January and December 2019. We relied on secondary data collected from all clients seen at Akisyon a Yesu Presbyterian Clinic's outpatient department in Nakaale. Data was extracted from Uganda's Health Management Information System records using Excel and exported to Stata for analysis. We labelled, categorised, and estimated frequencies and proportions for the variables. We estimated the means and medians for normally distributed or skewed variables respectively. A total of 14,685 observations, different diagnoses (n = 163) and residential locations or villages (n = 189) were extracted and included in the analysis. Nearly half (48.9%) of the clients were under the age of five years. Infectious diseases (42%), respiratory diseases (19%), and gastrointestinal and hepatic diseases (17%) were most commonly reported. While many clients (42%) reside in the sub-county where the health facility is located, a larger proportion (58%) came from further away, including 15% from outside of the local district. In conclusion, Akiyson a Yesu Presbyterian Clinic serves a very young population in a catchment area well beyond what is expected of a Health Centre II, in breadth of diagnoses, geographically, and in sheer numbers. Data gathered in this study will inform policy at the clinic, subcounty, and district levels enabling accurate health service delivery for the local context.
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Affiliation(s)
- Leah J Hopp
- Orthodox Presbyterian Uganda Mission, Akisyon a Yesu Presbyterian Clinic, Nakaale, Nakapiripirit, Uganda
| | | | - Christopher J Verdick
- Orthodox Presbyterian Uganda Mission, Akisyon a Yesu Presbyterian Clinic, Nakaale, Nakapiripirit, Uganda
| | - Agnes Napyo
- Department of Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Xu Y, Wang A, Lin X, Xu J, Shan Y, Pan X, Ye J, Shan P. Global burden and gender disparity of vision loss associated with diabetes retinopathy. Acta Ophthalmol 2021; 99:431-440. [PMID: 33124190 DOI: 10.1111/aos.14644] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/04/2020] [Accepted: 09/17/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To assess the trend patterns and gender disparity in global burden of vision loss due to diabetic retinopathy (DR) by year, age, region and socioeconomic status using prevalence and years lived with disability (YLDs) from Global Burden of Disease (GBD) study 2017. METHODS Prevalence and YLDs data of vision loss attributable to DR were extracted from GBD Study 2017 in 195 countries and territories. Socio-demographic Index (SDI) in 2017 was cited as indicators of socioeconomic status. Kruskal-Wallis test, Dunn's multiple comparisons and Pearson linear correlation were adopted to evaluate the gender disparity and association with socioeconomic levels. RESULTS Globally, total age-standardized prevalence and YLDs rates of vision loss due to DR peaked around 2005, with prevalence rate of 58.98 [95% uncertainty interval (UI) 50.95-68.56] and YLDs rate of 5.00 (95% UI 3.51-6.84) per 100 000 population, respectively. The burden were expected to increase to 65.74 (95% UI 60.14-70.86) and 5.68 (95% UI 4.07-7.22) by 2050. The burden would increase according to our projection based on current epidemiological situation. However, gender disparity has existed since 1990 and been enlarging in recent years, with female being more heavily impacted. This pattern remained with ageing among different stages of vision impairments and varied through GBD super regions. Gender difference (females minus males) of age-standardized prevalence rates was positively related to SDI (r = 0.1661, p = 0.0203). Diabetes has become a more important risk over the past 3 decades among the leading causes of vision loss. CONCLUSIONS The DR-related vision loss burden tended to increase under ageing population according to our projection with significant gender disparity. Public awareness of DR and gender sensitive health policy should be emphasized.
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Affiliation(s)
- Yufeng Xu
- Department of Ophthalmology College of Medicine the Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Aihong Wang
- Department of Endocrinology PLA Strategic Support Force Characteristic Medical Center Beijing China
| | - Xiling Lin
- Department of Endocrinology and Metabolism College of Medicine the Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Jingya Xu
- Department of Endocrinology and Metabolism College of Medicine the Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Yi Shan
- Department of Ophthalmology College of Medicine the Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Xiaowen Pan
- Department of Endocrinology and Metabolism College of Medicine the Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Juan Ye
- Department of Ophthalmology College of Medicine the Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Peng‐Fei Shan
- Department of Endocrinology and Metabolism College of Medicine the Second Affiliated Hospital of Zhejiang University Hangzhou China
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Greiner R, Nyrienda M, Rodgers L, Asiki G, Banda L, Shields B, Hattersley A, Crampin A, Newton R, Jones A. Associations between low HDL, sex and cardiovascular risk markers are substantially different in sub-Saharan Africa and the UK: analysis of four population studies. BMJ Glob Health 2021; 6:e005222. [PMID: 34016577 PMCID: PMC8141440 DOI: 10.1136/bmjgh-2021-005222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/11/2021] [Accepted: 05/05/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Low high-density lipoprotein (HDL) is widely used as a marker of cardiovascular disease risk, although this relationship is not causal and is likely mediated through associations with other risk factors. Low HDL is extremely common in sub-Saharan African populations, and this has often been interpreted to indicate that these populations will have increased cardiovascular risk. We aimed to determine whether the association between HDL and other cardiovascular risk factors differed between populations in sub-Saharan Africa and the UK. METHODS We compared data from adults living in Uganda and Malawi (n=26 216) and in the UK (n=8747). We examined unadjusted and adjusted levels of HDL and applied the WHO recommended cut-offs for prevalence estimates. We used spline and linear regression to assess the relationship between HDL and other cardiovascular risk factors. RESULTS HDL was substantially lower in the African than in the European studies (geometric mean 0.9-1.2 mmol/L vs 1.3-1.8 mmol/L), with African prevalence of low HDL as high as 77%. Total cholesterol was also substantially lower (geometric mean 3.3-3.9 mmol/L vs 4.6-5.4 mmol/L). In comparison with European studies the relationship between HDL and adiposity (body mass index, waist to hip ratio) was greatly attenuated in African studies and the relationship with non-HDL cholesterol reversed: in African studies low HDL was associated with lower non-HDL cholesterol. The association between sex and HDL was also different; using the WHO sex-specific definitions, low HDL was substantially more common among women (69%-77%) than men (41%-59%) in Uganda/Malawi. CONCLUSION The relationship between HDL and sex, adiposity and non-HDL cholesterol in sub-Saharan Africa is different from European populations. In sub-Saharan Africans low HDL is a marker of low overall cholesterol and sex differences are markedly attenuated. Therefore low HDL in isolation is unlikely to indicate raised cardiovascular risk and the WHO sex-based cut-offs are inappropriate.
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Affiliation(s)
- Rosamund Greiner
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | | | - Lauren Rodgers
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Louis Banda
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Beverly Shields
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Andrew Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Angus Jones
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
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Namale G, Kamacooko O, Makhoba A, Mugabi T, Ndagire M, Ssanyu P, Ddamulira J, Yperzeele L, Cras P, Ddumba E, Seeley J, Newton R. HIV sero-positivity and risk factors for ischaemic and haemorrhagic stroke in hospitalised patients in Uganda: A prospective-case-control study. Public Health Pract (Oxf) 2021; 2:100128. [PMID: 36101575 PMCID: PMC9461590 DOI: 10.1016/j.puhip.2021.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 03/01/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives We examined HIV sero-positivity and risk factors in patients admitted with ischaemic stroke (IS) and haemorrhagic stroke (HS) in Kampala, Uganda. Study design We conducted a matched case-control study between December 2016 and December 2018 at St Francis Hospital, Nsambya. Methods The study population comprised of stroke cases (adults aged ≥18 years with IS or HS confirmed by neuroimaging) and controls (age- and sex-matched stroke-free adults aged ≥18 years who were recruited from the same hospital as the cases). A comprehensive assessment for sociodemographic, lifestyle and clinical factors was performed using the World Health Organization (WHO) STEP-wise approach to Surveillance (STEPS) for stroke risk factor surveillance. We used conditional logistic regression to identify risk factors associated with IS or HS. Results We enrolled 137 matched case-control pairs; 48 (35%) were men, and the mean ages were 62.4 years (SD ± 14.8) for cases and 61.1 years (SD ± 14.1) for controls. Of stroke patients, 86 (63%) had IS and 51 (37%) had HS. Overall, HIV sero-positivity was 10% among stroke cases versus 7% among controls. HIV sero-positivity was not significantly associated with stroke (unadjusted odds ratio [uOR] = 1.49, 95% confidence interval [CI] 0.59-3.78). A self-reported family history of diabetes mellitus was associated with an increased risk of all stroke (adjusted odds ratio [aOR] = 4.41, 95% CI 1.47-13.2), as well as for IS and HS separately (aOR = 3.66, 95% CI 1.09-12.4 and aOR = 4.99, 95% CI 1.02-24.4, respectively). High blood pressure (≥140/90 mmHg) was associated with an increased risk of all stroke (aOR = 12.3, 95% CI 42-44.1), and this was also true for IS and HS individually (aOR = 6.48, 95% CI 1.15-36.7 and aOR = 5.63, 95% CI 1.74-18.2, respectively). Conclusions No association was found between HIV sero-positivity and stroke occurrence among Ugandan stroke patients. Hypertension and a self-reported family history of diabetes mellitus were significant risk factors for both IS and HS. Interventions to reduce hypertension and diabetes mellitus in the Ugandan population are urgently required. Much larger studies are required to demonstrate if any association exists between HIV and stroke.
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Affiliation(s)
- G. Namale
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,Corresponding author. MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.
| | - O. Kamacooko
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - A. Makhoba
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - T. Mugabi
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - M. Ndagire
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - P. Ssanyu
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - J.B.M. Ddamulira
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - L. Yperzeele
- University of Antwerp, Department of Neurology, Antwerp, Belgium
| | - P. Cras
- University of Antwerp, Department of Neurology, Antwerp, Belgium
| | - E. Ddumba
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - J. Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,London School of Hygiene &Tropical Medicine, London, UK
| | - R. Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,University of York, York, UK
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Natukwatsa D, Wosu AC, Ndyomugyenyi DB, Waibi M, Kajungu D. An assessment of non-communicable disease mortality among adults in Eastern Uganda, 2010-2016. PLoS One 2021; 16:e0248966. [PMID: 33739993 DOI: 10.1371/journal.pone.0248966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/08/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is a dearth of studies assessing non-communicable disease (NCD) mortality within population-based settings in Uganda. We assessed mortality due to major NCDs among persons ≥ 30 years in Eastern Uganda from 2010 to 2016. METHODS The study was carried out at the Iganga-Mayuge health and demographic surveillance site in the Iganga and Mayuge districts of Eastern Uganda. Information on cause of death was obtained through verbal autopsies using a structured questionnaire to conduct face-face interviews with carers or close relatives of the deceased. Physicians assigned likely cause of death using ICD-10 codes. Age-adjusted mortality rates were calculated using direct method, with the average population across the seven years of the study (2010 to 2016) as the standard. Age categories of 30-40, 41-50, 51-60, 61-70, and ≥ 71 years were used for standardization. RESULTS A total of 1,210 deaths among persons ≥ 30 years old were reported from 2010 to 2016 (50.7% among women). Approximately 53% of all deaths were due to non-communicable diseases, 31.8% due to communicable diseases, 8.2% due to injuries, and 7% due to maternal-related deaths or undetermined causes. Cardiovascular diseases accounted for the largest proportion of NCD deaths in each year, and women had substantially higher cardiovascular disease mortality rates compared to men. Conversely, women had lower diabetes mortality rates than men for five of the seven years examined. CONCLUSIONS Non-communicable diseases are major causes of death among adults in Iganga and Mayuge; and cardiovascular diseases and diabetes are leading causes of NCD deaths. Efforts are needed to tackle NCD risk factors and provide NCD care to reduce associated burden and premature mortality.
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Kibr G. Food Choice Behaviors of Lactating Women: Association with Body Mass Index and Fruits and Vegetables Intake in Central Amhara Region, Ethiopia-An Observational Study. J Nutr Metab 2021; 2021:6654659. [PMID: 33728060 PMCID: PMC7937472 DOI: 10.1155/2021/6654659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND What food people choose to eat is embraced by circumstances that are essentially influenced by the underlying motives of food choices which are important to a healthful dietary change. Therefore, this study aimed to explore food choice behaviors associated with nutritional status and FVs intake in women during lactation from central Amhara. METHODS A multistage sampling technique was applied to select study participants. A study was conducted among 423 randomly selected lactating women using a face-to-face interview of the questionnaire. A community-based cross-sectional, quantitative study with descriptive and analytical components was done. Anthropometrics measurements such as weight, height, waist, and hip circumference were taken from all participants. Body mass index was calculated to determine the nutritional status of women. Data were analyzed using SPSS version 20 computer software program. Association between dependent and independent variables was identified by logistic regression analysis, and a P-value< 0.05 was taken as statistically significant. RESULTS About 21.7% of women were underweight. Approximately 37.4% of women had good consumption trends to fruits and vegetables. Healthy meal eating motivation, price-consciousness, and mood concern were identified as the most significant behaviors of food choice, influencing the nutritional status of women with AOR (95% CI) of 2.1 (1.21-3.62), 3.01 (1.32-6.9), and 0.5 (0.30-0.95), respectively. Natural content (AOR (95%): 2.37 (1.39-4.06)), mood concern (AOR (95%): 2.29 (1.15-4.56)), religion concern (AOR (95%): 2.45 (1.37-4.4)), husband encouragement (AOR (95%): 2.26 (1.04-4.89)), and availability of milk and milk products (AOR (95%): 1.6 (1.39-2.74)) and fruits and vegetables (AOR (95%): 1.66 (1.16-3.48)) in home were associated significantly with a good intake of fruit and vegetables. CONCLUSIONS This finding provides a useful insight into the food choice motivations of a group of women with preference for natural foods, mood concern, religion concern, and husband support with good fruit and vegetable intake. This can help practitioners make recommendations for health promotion strategies. Emphasis on assisting women with healthy meal eating and avoiding psychological stress is important. Nutrition education about healthy food choice is recommended for communities.
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Affiliation(s)
- Gesessew Kibr
- Department of Food and Nutritional Sciences, Faculty of Agriculture, Shambu Campus, Wollega University, Shambu, Ethiopia
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Thirlway F, Nyamurungi KN, Matovu JKB, Miti AK, Mdege ND. Tobacco use and cessation in the context of ART adherence: Insights from a qualitative study in HIV clinics in Uganda. Soc Sci Med 2021; 273:113759. [PMID: 33631533 PMCID: PMC7610397 DOI: 10.1016/j.socscimed.2021.113759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/24/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
Sub-Saharan Africa carries a disproportionate burden of human immunodeficiency virus (HIV). Tobacco use amongst people living with HIV is higher than in the general population even though it increases the risk of life-threatening opportunistic infections including tuberculosis (TB). Research on tobacco use and cessation amongst people living with HIV in Africa is sparse and it is not clear what interventions might achieve lasting cessation. We carried out qualitative interviews in Uganda in 2019 with 12 current and 13 former tobacco users (19 men and 6 women) receiving antiretroviral therapy (ART) in four contrasting locations. We also interviewed 13 HIV clinic staff. We found that tobacco use and cessation were tied into the wider moral framework of ART adherence, but that the therapeutic citizenship fashioned by ART regimes was experienced more as social control than empowerment. Patients were advised to stop using tobacco; those who did not concealed this from health workers, who associated both tobacco and alcohol use with ART adherence failure. Most of those who quit tobacco did so following the biographical disruption of serious TB rather than HIV diagnosis or ART treatment, but social support from family and friends was key to sustained cessation. We put forward a model of barriers and facilitators to smoking cessation and ART adherence based on engagement with either ‘reputation’ or ‘respectability’. Reputation involved pressure to enjoy tobacco with friends whereas family-oriented respectability demanded cessation, but those excluded by isolation or precarity escaped anxiety and depression by smoking and drinking with their peers. People living with HIV in Uganda hid their tobacco use from health workers. The experience of tuberculosis was the most common trigger to quit smoking. Engagement with ‘respectable’ masculinity promoted smoking cessation. Engagement with ‘reputational’ masculinity made it hard to quit. This model has wider applicability for antiretroviral therapy adherence.
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Affiliation(s)
- Frances Thirlway
- Department of Sociology, University of York, York, YO10 5DD, UK.
| | - Kellen Namusisi Nyamurungi
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala P.O Box 7072, Kampala, Uganda
| | - Joseph K B Matovu
- Department of Community & Public Health Faculty of Health Sciences, Busitema University, Mbale, Uganda; Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Uganda
| | - Andrew Kibuuka Miti
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala P.O Box 7072, Kampala, Uganda
| | - Noreen Dadirai Mdege
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD, UK
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12
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Do S, Lohmann J, Brenner S, Koulidiati JL, Souares A, Kuunibe N, Hamadou S, Hien H, Winkler V, De Allegri M. Patterns of healthcare seeking among people reporting chronic conditions in rural sub-Saharan Africa: findings from a population-based study in Burkina Faso. Trop Med Int Health 2020; 25:1542-1552. [PMID: 32981177 DOI: 10.1111/tmi.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Non-communicable diseases are rapidly becoming one of the leading causes of morbidity and mortality in sub-Saharan Africa. Yet, little is known about patterns of healthcare seeking among people with chronic conditions in these settings. We aimed to explore determinants of healthcare seeking among people who reported at least one chronic condition in rural Burkina Faso. METHODS Data were drawn from a cross-sectional population-based survey conducted across 24 districts on 52 562 individuals from March to June 2017. We used multinomial logistic regression to assess factors associated with seeking care at a formal provider (facility-based care) or at an informal provider (home and traditional treatment) compared to no care. RESULTS 1124 individuals (2% of all respondents) reported at least one chronic condition. Among those, 22.8% reported formal care use, 10.6% informal care use, and 66.6% no care. The presence of other household members reporting a chronic condition (RRR = 0.57, 95%-CI [0.39, 0.82]) was negatively associated with seeking formal care. Wealthier households (RRR = 2.14, 95%-CI [1.26, 3.64]), perceived illness severity (RRR = 3.23, 95%-CI [2.22, 4.70]) and suffering from major chronic conditions (RRR = 1.54, 95%-CI [1.13, 2.11]) were positively associated with seeking formal care. CONCLUSION Only a minority of individuals with chronic conditions sought formal care, with important differences due to socio-economic status. Policies and interventions aimed at increasing the availability and affordability of services for early detection and management in peripheral settings should be prioritised.
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Affiliation(s)
- Stefanie Do
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany.,Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Julia Lohmann
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany.,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephan Brenner
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Jean-Louis Koulidiati
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Aurelia Souares
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Naasegnibe Kuunibe
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany.,University for Development Studies, Tamale, Ghana
| | - Saidou Hamadou
- The World Bank, Health, Nutrition, Population Global Practice, Washington, DC, USA
| | - Hervé Hien
- Centre Muraz, National Public Health Institute (NPHI), Bobo-Dioulasso, Hauts-Bassins, Burkina Faso.,Research and Heath Science Institute (IRSS), Ouagadougou, Burkina Faso
| | - Volker Winkler
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, Heidelberg University, Heidelberg, Germany
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13
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Lin X, Xu Y, Xu J, Pan X, Song X, Shan L, Zhao Y, Shan PF. Global burden of noncommunicable disease attributable to high body mass index in 195 countries and territories, 1990-2017. Endocrine 2020; 69:310-320. [PMID: 32488838 DOI: 10.1007/s12020-020-02352-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The increasing burden of noncommunicable diseases (NCDs) attributable to high body mass index (BMI) represents both a threat and an opportunity for intervention. Estimates of the global latest trend of high BMI-related NCDs and its association with socioeconomic status can facilitate strategic intervention and inform further research. METHODS This global burden of disease study extracted global, regional, and national data on death and disability-adjusted life years (DALYs) attributable to high BMI-related NCDs from the GBD Study 2017. Secondary analyses were performed by year, age, sex, and specific causes of death and DALYs. The 2017 Socio-demographic Index (SDI) was used as an indicator of national socioeconomic status. The association between age-standardized death or DALYs rate and socioeconomic status were analyzed. RESULTS Worldwide, 4.7 million deaths and 147.7 million DALYs of NCDs were related to high BMI in 2017, with a projection to 5.5 million deaths and 176.9 million DALYs in 2025. Globally, high BMI-related burden showed an increasing trend with males being more heavily impacted overall. The trend and magnitude of high BMI-related disease burden varied substantially in different geographical and socioeconomic regions. Specifically, the low-middle, middle, and high-middle SDI countries were associated with a higher burden. The leading three causes of DALYs attributable to high BMI in 2017 were ischemic heart diseases, stroke, and diabetes mellitus. CONCLUSIONS High BMI-related burden of NCDs is worsening, particularly in developing countries. Our findings may enhance public awareness of interventions to reduce the diseases burden caused by high BMI.
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Affiliation(s)
- Xiling Lin
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Yufeng Xu
- Department of Ophthalmology, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Jingya Xu
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Xiaowen Pan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Xiaoxiao Song
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Lizhen Shan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Yiming Zhao
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China
| | - Peng-Fei Shan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of ZheJiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China.
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14
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Nalwoga A, Webb EL, Muserere C, Chihota B, Miley W, Labo N, Elliott A, Cose S, Whitby D, Newton R. Variation in KSHV prevalence between geographically proximate locations in Uganda. Infect Agent Cancer 2020; 15:49. [PMID: 32714434 PMCID: PMC7376633 DOI: 10.1186/s13027-020-00313-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/15/2020] [Indexed: 01/25/2023] Open
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) transmission within endemic areas may vary. KSHV seroprevalence has been studied by different groups of researchers using different methods, making it difficult to make direct comparisons. Here we show results on KSHV seroprevalence using the same laboratory method from four different but geographically proximate populations in Uganda. Blood samples from the urban Entebbe Mother and Baby Study (EMaBS), the rural General Population Cohort (GPC), the fishing community Lake Victoria Island Intervention Study on Worms and Allergy related Diseases (LaVIISWA) and the high-risk sexual behaviour Good Health for Women Project (GHWP), were tested for IgG antibody levels to K8.1 and ORF73 recombinant proteins using ELISA. All adult participants of the EMaBS study and the GHWP were women, while the GPC (54% female) and LaVIISWA (52% female) studies had both males and females. EMaBS children were all 5 years of age while their mothers were 14 to 47 years of age. GHWP women were 15 to 45 years old, LaVIISWA participants were 1 to 72 years old while GPC participants were 1 to 103 years old. KSHV seropositivity varied in the different populations. In children aged 5 years, EMaBS had the lowest prevalence of 15% followed by GPC at 35% and LaVIISWA at 54%. In adult women, seropositivity varied from 69% (EMaBS) to 80% (LaVIISWA) to 87% (GPC) to 90% (GHWP). The reasons for the variation in prevalence are unclear but may reflect differences in the prevalence of cofactors between these four geographically proximate populations.
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Affiliation(s)
- Angela Nalwoga
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Immunology and Microbiology, University of Colorado, Anschutz Medical Campus, Aurora, CO USA
| | - Emily L Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - Alison Elliott
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Cose
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene & Tropical Medicine, London, UK
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD USA
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15
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Koopman JJ. Exploring risk factors of peripheral arterial disease across populations with various lifestyles and environments. Int J Cardiol 2020; 305:135-136. [DOI: 10.1016/j.ijcard.2020.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 11/25/2022]
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16
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O'Hara G, Mokaya J, Hau JP, Downs LO, McNaughton AL, Karabarinde A, Asiki G, Seeley J, Matthews PC, Newton R. Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors. BMJ Open 2020; 10:e032890. [PMID: 32234740 PMCID: PMC7170602 DOI: 10.1136/bmjopen-2019-032890] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population. DESIGN We undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). SETTING We studied a population cohort in South-Western Uganda. PARTICIPANTS Data were available for 8099 adults (median age 30 years; 56% female). RESULTS The prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption. CONCLUSIONS Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.
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Affiliation(s)
- Geraldine O'Hara
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jolynne Mokaya
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
| | - Jeffrey P Hau
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Louise O Downs
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Alex Karabarinde
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Gershim Asiki
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Philippa C Matthews
- Nuffied Department of Medicine, University of Oxford, Oxford, UK
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR BRC, John Radcliffe Hospital, Oxford, UK
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
- Department of Health Sciences, University of York, York, UK
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17
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Kavishe B, Vanobberghen F, Katende D, Kapiga S, Munderi P, Baisley K, Biraro S, Mosha N, Mutungi G, Mghamba J, Hughes P, Smeeth L, Grosskurth H, Peck R. Dyslipidemias and cardiovascular risk scores in urban and rural populations in north-western Tanzania and southern Uganda. PLoS One 2019; 14:e0223189. [PMID: 31809516 PMCID: PMC6897412 DOI: 10.1371/journal.pone.0223189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/16/2019] [Indexed: 01/06/2023] Open
Abstract
Background Dyslipidemia is a leading risk factor for atherosclerotic cardiovascular disease. There are few published epidemiological data regarding dyslipidemia in Africa. We determined full lipid and apolipoprotein profiles and investigated factors associated with lipid levels in urban and rural populations of north-western Tanzania and southern Uganda. Methods We conducted a cross-sectional survey of randomly-selected, community-dwelling adults (≥18yrs) including five strata per country: one municipality, two district towns and two rural areas. Participants were interviewed and examined using the World Health Organization STEPwise survey questionnaire. Serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and apolipoproteins were measured. Factors associated with mean lipid levels were assessed by multivariable linear regression. Framingham 10-year cardiovascular risk scores were calculated with and without lipids. Results One-third of adults in the study population had dyslipidemia. Low high-density lipoprotein cholesterol affected 32–45% of rural adults. High total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B were found in <15% of adult population in all strata, but were more common in urban adults. Factors independently associated with higher mean low-density lipoprotein cholesterol and apolipoprotein B were female gender, older age, higher education, higher income, obesity, and hypertension. Framingham cardiovascular risk scores with and without lipids yielded similar results and 90% of study subjects in all strata were classified as “low risk”. Among older adults (>55 years), 30% were classified as “high” or “very high” risk. Conclusions Dyslipidemias are common among adults in north-western Tanzania and southern Uganda affecting one third of adult population. Overall, cardiovascular risk scores are low but high risk scores are common with older adults. Health services designed and equipped to diagnose and treat dyslipidemia are urgently needed.
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Affiliation(s)
- Bazil Kavishe
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Fiona Vanobberghen
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.,MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Katende
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.,MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paula Munderi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Kathy Baisley
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Samuel Biraro
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Neema Mosha
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Janneth Mghamba
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Peter Hughes
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Liam Smeeth
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.,MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Peck
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.,Weill Bugando School of Medicine, Mwanza, Tanzania.,Weill Cornell Medical College, New York, NY, United States of America
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18
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Auguste A, Dugas J, Menvielle G, Barul C, Richard JB, Luce D. Social distribution of tobacco smoking, alcohol drinking and obesity in the French West Indies. BMC Public Health 2019; 19:1424. [PMID: 31666052 PMCID: PMC6822355 DOI: 10.1186/s12889-019-7802-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/17/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Tobacco smoking, alcohol and obesity are important risk factors for a number of non-communicable diseases. The prevalence of these risk factors differ by socioeconomic group in most populations, but this socially stratified distribution may depend on the social and cultural context. Little information on this topic is currently available in the Caribbean. The aim of this study was to describe the distribution of tobacco smoking, alcohol drinking and obesity by several socioeconomic determinants in the French West Indies (FWI). METHODS We used data from a cross-sectional health survey conducted in Guadeloupe and Martinique in 2014 in a representative sample of the population aged 15-75 years (n = 4054). All analyses were stratified by gender, and encompassed sample weights, calculated to account for the sampling design and correct for non-response. For each risk factor, we calculated weighted prevalence by income, educational level, occupational class and having hot water at home. Poisson regression models were used to estimate age-adjusted prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS Current smoking and harmful chronic alcohol use were more common in men than in women (PR = 1.80, 95% CI = 1.55-2.09; PR = 4.53, 95% CI = 3.38-6.09 respectively). On the other hand, the prevalence of obesity was higher in women than in men (PR = 0.67, 95% CI = 0.57-0.79). Higher education, higher occupational class and higher income were associated with lower prevalence of harmful alcohol drinking in men (PR = 0.43, 95% CI = 0.25-0.72; PR = 0.73, 95% CI = 0.53-1.01; PR = 0.72, 95% CI = 0.51-1.03 respectively), but not in women. For tobacco smoking, no variation by socioeconomic status was observed in men whereas the prevalence of current smoking was higher among women with higher occupational class (PR = 1.47, 95% CI = 1.13-1.91) and higher income (PR = 1.50, 95% CI = 1.11-2.03). In women, a lower prevalence of obesity was associated with a higher income (PR = 0.43, 95% CI = 0.33-0.56), a higher occupational class (PR = 0.63, 95% CI = 0.50-0.80), a higher educational level (PR = 0.36, 95% CI = 0.26-0.50) and having hot water at home (PR = 0.65, 95% CI = 0.54-0.80). CONCLUSION Women of high socio-economic status were significantly more likely to be smokers, whereas alcohol drinking in men and obesity in women were inversely associated with socioeconomic status.
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Affiliation(s)
- Aviane Auguste
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, F-97100 Pointe-à-Pitre, France
| | - Julien Dugas
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, F-97100 Pointe-à-Pitre, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), F75012 Paris, France
| | - Christine Barul
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, F-97100 Pointe-à-Pitre, France
| | - Jean-Baptiste Richard
- Santé publique France, French National Public Health Agency, 12 rue du val d’Osne, F-94415 Saint Maurice, France
| | - Danièle Luce
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) -UMR_S 1085, F-97100 Pointe-à-Pitre, France
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19
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Nsonga J, Dongo JP, Mugabe F, Mutungi G, Walyomo R, Oundo C, Zalwango S, Okello D, Muchuro S, Dlodlo RA, Lin Y. Screening tuberculosis patients for diabetes mellitus in a routine program setting in Kampala, Uganda: a cross-sectional study. F1000Res 2019; 8:872. [PMID: 31681473 PMCID: PMC6816448 DOI: 10.12688/f1000research.19279.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 10/15/2023] Open
Abstract
Background: Uganda is located in East Africa and is among the countries with the lowest income globally. The ten health centres in this project serve populations in the under-privileged communities of Kampala. The objective of the study was to implement diabetes mellitus (DM) screening among tuberculosis (TB) patients in a routine program setting with limited resources and high human immunodeficiency virus (HIV) prevalence. Methods: A descriptive cross-sectional observational study was conducted in ten health centres in Kampala, Uganda. As part of a project to implement DM screening in a routine setting, TB patients were screened for DM by trained health workers. A fasting blood glucose (FBG) value ≥7.0mmol/l was considered to indicate DM. For this study, aggregate data was collected and analysed using SPSS for Windows, version 13.0. Results: Among 4,590 TB patients registered, 4,016 (88.0%) were screened with random blood glucose (RBG). Of those with RBG ≥6.1mmol/l, 1,093 (83.3%) were screened with FBG. In total, 92 (2.3%) patients were diagnosed with DM and 66 (71.8%) of them were newly diagnosed. The proportion of TB patients screened with FBG in the health centres varied from 58.2% to 100%. The proportion of patients screened with FBG and the prevalence of DM were significantly higher in private health centres compared with public health centres. The health centres in peri-urban areas screened more patients with RBG than those in urban areas. Health centres without DM services screened a larger number of patients with RBG and FBG than those with DM services. Conclusions: It appears feasible to implement screening TB patients for DM in routine program settings with limited resources and high HIV prevalence. Its introduction requires close collaboration between TB and DM services. The challenges identified need government attention and certain institutional and service-related factors need to be better managed at times.
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Affiliation(s)
- Joseph Nsonga
- International Union Against Tuberculosis and Lung Disease, Plot 2, Lourdel Road, Nakasero Hill, Kampala, Uganda
| | - John Paul Dongo
- International Union Against Tuberculosis and Lung Disease, Plot 2, Lourdel Road, Nakasero Hill, Kampala, Uganda
| | - Frank Mugabe
- The National Tuberculosis and Leprosy Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
| | - Gerald Mutungi
- The Non-Communicable Diseases Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
| | - Richard Walyomo
- Kampala Capital City Authority, City Hall, Plot 1-3, Apollo Kaggwa Road, Kampala, Uganda
| | - Christopher Oundo
- Kampala Capital City Authority, City Hall, Plot 1-3, Apollo Kaggwa Road, Kampala, Uganda
| | - Sarah Zalwango
- Kampala Capital City Authority, City Hall, Plot 1-3, Apollo Kaggwa Road, Kampala, Uganda
| | - Daniel Okello
- Kampala Capital City Authority, City Hall, Plot 1-3, Apollo Kaggwa Road, Kampala, Uganda
| | - Simon Muchuro
- The National Tuberculosis and Leprosy Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- University Research Company on USAID Defeat Project, Plot 40 Ntinda II Road, Naguru, Kampala, Uganda
| | - Riitta A Dlodlo
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint-Michel, Paris, 75006, France
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint-Michel, Paris, 75006, France
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Nsonga J, Dongo JP, Mugabe F, Mutungi G, Walyomo R, Oundo C, Zalwango S, Okello D, Muchuro S, Dlodlo RA, Lin Y. Screening tuberculosis patients for diabetes mellitus in a routine program setting in Kampala, Uganda: a cross-sectional study. F1000Res 2019; 8:872. [PMID: 31681473 PMCID: PMC6816448 DOI: 10.12688/f1000research.19279.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Uganda is located in East Africa and is among the countries with the lowest income globally. The ten health centres in this project serve populations in the under-privileged communities of Kampala. The objective of the study was to implement diabetes mellitus (DM) screening among tuberculosis (TB) patients in a routine program setting with limited resources and high human immunodeficiency virus (HIV) prevalence. Methods: A descriptive cross-sectional observational study was conducted in ten health centres in Kampala, Uganda. As part of a project to implement DM screening in a routine setting, TB patients were screened for DM by trained health workers. A fasting blood glucose (FBG) value ≥7.0mmol/l was considered to indicate DM. For this study, aggregate data was collected and analysed using SPSS for Windows, version 13.0. Results: Among 4,590 TB patients registered, 4,016 (88.0%) were screened with random blood glucose (RBG). Of those with RBG ≥6.1mmol/l, 1,093 (83.3%) were screened with FBG. In total, 92 (2.3%) patients were diagnosed with DM and 66 (71.8%) of them were newly diagnosed. The proportion of TB patients screened with FBG in the health centres varied from 58.2% to 100%. The proportion of patients screened with FBG and the prevalence of DM were significantly higher in private health centres compared with public health centres. The health centres in peri-urban areas screened more patients with RBG than those in urban areas. These health centres without DM services screened a larger number of patients with RBG and FBG than those with DM services. Conclusions: It appears feasible to implement screening TB patients for DM in routine program settings with limited resources and high HIV prevalence. Its introduction requires close collaboration between TB and DM services. The challenges identified need government attention and certain institutional and service-related factors need to be better managed at times.
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Affiliation(s)
- Joseph Nsonga
- International Union Against Tuberculosis and Lung Disease, Plot 2, Lourdel Road, Nakasero Hill, Kampala, Uganda
| | - John Paul Dongo
- International Union Against Tuberculosis and Lung Disease, Plot 2, Lourdel Road, Nakasero Hill, Kampala, Uganda
| | - Frank Mugabe
- The National Tuberculosis and Leprosy Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
| | - Gerald Mutungi
- The Non-Communicable Diseases Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
| | - Richard Walyomo
- Kampala Capital City Authority, City Hall, Plot 1-3, Apollo Kaggwa Road, Kampala, Uganda
| | - Christopher Oundo
- Kampala Capital City Authority, City Hall, Plot 1-3, Apollo Kaggwa Road, Kampala, Uganda
| | - Sarah Zalwango
- Kampala Capital City Authority, City Hall, Plot 1-3, Apollo Kaggwa Road, Kampala, Uganda
| | - Daniel Okello
- Kampala Capital City Authority, City Hall, Plot 1-3, Apollo Kaggwa Road, Kampala, Uganda
| | - Simon Muchuro
- The National Tuberculosis and Leprosy Program, Ministry of Health, Plot 6, Lourdel Road, Nakasero, Kampala, Uganda
- University Research Company on USAID Defeat Project, Plot 40 Ntinda II Road, Naguru, Kampala, Uganda
| | - Riitta A Dlodlo
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint-Michel, Paris, 75006, France
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint-Michel, Paris, 75006, France
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Noubiap JJ, Balti EV, Bigna JJ, Echouffo-Tcheugui JB, Kengne AP. Dyslipidaemia in Africa-comment on a recent systematic review - Authors' reply. Lancet Glob Health 2018; 7:e308-e309. [PMID: 30553650 DOI: 10.1016/s2214-109x(18)30517-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Eric Vounsia Balti
- Diabetes Research Center, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Internal Medicine, Universiteit Ziekenhuis Brussel, Brussels, Belgium
| | - Jean Joel Bigna
- Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - André Pascal Kengne
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
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Kabwama SN, Kirunda B, Mutungi G, Wesonga R, Bahendeka SK, Guwatudde D. Prevalence and correlates of abdominal obesity among adults in Uganda: findings from a national cross-sectional, population based survey 2014. BMC Obes 2018; 5:40. [PMID: 30524745 PMCID: PMC6276139 DOI: 10.1186/s40608-018-0217-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/06/2018] [Indexed: 12/13/2022]
Abstract
Background Overweight and obesity are associated with health complications the gravity of which, vary with the regional deposition of the excess fat. The Body Mass Index (BMI) is often used to measure obesity although is an inferior predictor of cardiovascular disease risk mortality and morbidity compared with measures of abdominal obesity. We analyzed data from Uganda’s 2014 World Health Organization (WHO) STEPwise approach to surveillance of Non-communicable diseases (NCDs) survey to estimate the prevalence of abdominal obesity and associated factors to provide information on the prevention and control of overweight and obesity. Methods Data were collected using the WHO STEPS protocol. Waist measurement was taken using a non-stretchable standard tape measure mid-way between the lowest rib and iliac crest with the subject standing at the end of gentle expiration. Participants with waist circumference > 102 cm for men and 88 cm for women were classified as abdominally obese. We used weighted modified Poisson regression with robust error variance to estimate the prevalence of abdominal obesity and associated factors. Results Of the 3676 participants, 432 (11.8%) were abdominally obese; with the prevalence higher among females 412 (19.5%) compared with males 20 (1.3%). Compared with males, female participants were more likely to be abdominally obese Adjusted Prevalence Rate Ratio (APRR) 7.59 [5.58–10.33]. Participants who were married or cohabiting APRR 1.82 [1.29–2.57] and participants who were separated or divorced APRR 1.69 [1.17–2.46] were more likely to be abdominally obese compared with those who had never married before. Compared with rural dwellers, participants from urban areas were more likely to be abdominally obese APRR 1.29 [1.09–1.53]. Compared with participants with normal blood pressure, those with elevated blood pressure were more likely to be abdominally obese APRR 1.83 [1.57–2.14].Compared with participants without any education, those with secondary education were more likely to be abdominally obese APRR 1.42 [1.12–1.78]. Conclusions There is a high prevalence of abdominal obesity among adults in Uganda which puts many at risk of developing associated metabolic complications. These data provide useful information for developing interventions and formulation of policies for the control and prevention of abdominal obesity in Uganda.
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Affiliation(s)
| | - Barbara Kirunda
- 1Makerere University School of Public Health, Kampala, Uganda
| | - Gerald Mutungi
- 2Control of Non-Communicable Diseases Desk, Ministry of Health, Kampala, Uganda
| | - Ronald Wesonga
- 3School of Statistics and Planning, Makerere University College of Business and Management Sciences, Kampala, Uganda
| | | | - David Guwatudde
- 5Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Dutta A, Kavitha AK, Samal S, Panigrahi P, Swain S, Nanda L, Pati S. Independent urban effect on hypertension of older Indians: identification of a knowledge gap from a Study on Global AGEing and Health. ACTA ACUST UNITED AC 2018; 12:e9-e17. [PMID: 30377047 DOI: 10.1016/j.jash.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 08/06/2018] [Accepted: 09/08/2018] [Indexed: 11/26/2022]
Abstract
Among older Indians, more cardiovascular diseases and risk factors are observed in the city dwellers than in the rural population. Clustering of socioeconomic privileges and consequent obesity in the Indian cities are known to underlie this phenomenon. But, it is unclear whether an independent urban effect exists on age-related ailments, unexplained by concentration of privileges and excess weight in the Indian cities. Hence, we aimed to estimate the independent urban effect on hypertension among older Indians after controlling for these factors. Nationally representative data of Indians aged 50 years and older (n = 7273) were collected by Study on global AGEing and health. Hypertension was defined as systolic and/or diastolic blood pressure >139 and > 89 mm Hg, respectively, and/or someone receiving antihypertensive medications. Permanent place of residence (urban/rural) during interview was recorded. Socioeconomic determinants included caste, occupation, assets, and education. Body mass index, abdominal circumference, smoking, alcohol, and physical activity were also controlled. The age- and sex-adjusted odds ratio of hypertension for urban residents was 1.64 (146-1.83), which partially attenuated to 1.22 (1.07-1.38) after controlling for all the covariates. This study highlights 22% excess odds of hypertension among the older Indian city dwellers, unexplained by the greater urban concentration of socioeconomic privileges and obesity. Future research should explore the constituents of this urban effect.
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Affiliation(s)
- Ambarish Dutta
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, Odisha, India; KIIT School of Public Health, KIIT Deemed to be University, Bhubaneswar, Odisha, India.
| | | | - Sudipta Samal
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, Odisha, India
| | - Pinaki Panigrahi
- Center for Global Health and Development, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shubhashisa Swain
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, Odisha, India
| | - Lipika Nanda
- Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- Regional Medical Research Centre (RMRC), Indian Council of Medical Research, Bhubaneswar, Odisha, India
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Thomas R, Burger R, Hauck K. Richer, wiser and in better health? The socioeconomic gradient in hypertension prevalence, unawareness and control in South Africa. Soc Sci Med 2018; 217:18-30. [PMID: 30292072 DOI: 10.1016/j.socscimed.2018.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
Abstract
The socioeconomic gradient in chronic conditions is clear in the poorest and wealthiest of countries, but extant evidence on this relationship in low- and middle-income countries is inconclusive. We use data gathered between 2008 and 2012 from a nationally representative sample of over 10,000 South African adults, and objective health measures to analyse the differential effects of education, income and other factors on the prevalence of hypertension, individuals' awareness and control of hypertensive status. Prevalence of hypertension is high at 38% among women and 34% among men. 59% of hypertensive individuals are unaware of their status. We find prevalence and unawareness of hypertension are a public health concern across all income groups in South Africa. Higher income is however associated with effective control amongst men. Completing secondary education is associated with 7 mmHg lower blood pressure only in a small sub-group of women but is associated with 22 percentage point higher likelihood of effective hypertension control amongst women. We conclude that poorer and less educated individuals are particularly at high risk of cardiovascular disease in South Africa.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, South Africa
| | - Katharina Hauck
- School of Public Health, Imperial College London, United Kingdom
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Rush KL, Goma FM, Barker JA, Ollivier RA, Ferrier MS, Singini D. Hypertension prevalence and risk factors in rural and urban Zambian adults in western province: a cross-sectional study. Pan Afr Med J 2018; 30:97. [PMID: 30344881 PMCID: PMC6191248 DOI: 10.11604/pamj.2018.30.97.14717] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/25/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Hypertension is a longstanding problem in Zambia, yet little is known about its prevalence and risk factors, particularly in rural and urban settings. Identifying geographical variations in hypertension is important to enhance the health of adult Zambians regardless of where they live. Therefore, the purpose of this study was to compare the prevalence of hypertension and related risk factors between rural (n = 130) and urban (n = 131) communities in Western Province, Zambia. Methods This cross-sectional study included urban and rural adult Zambians attending health checks who completed a modified World Health Organization (WHO) survey, and had blood pressure and anthropometric measurements completed. Descriptive statistics were used to summarize demographic and risk factor variables. Chi-square tests of association were used to analyze relationships between categorical variables, t-tests to analyze relationships between continuous variables and logistic regression to examine associations of hypertension with selected risk factors. Results The prevalence of hypertension in rural Zambians was double (46.9%) that of urban Zambians (22.9%). Increasing age, not engaging in walking/biking, and alcohol intake within the last 30 days were associated with an increased likelihood of hypertension in rural Zambians while eating vegetables more days during the week was associated with a decreased likelihood of hypertension in rural Zambians. Body Mass Index (BMI) was significantly associated with an increased likelihood of hypertension in urban Zambians. Conclusion Modifiable risk factors (such as BMI, dietary intake, and physical activity) are associated with hypertension prevalence in this population, indicating opportunities for screening and other prevention measures.
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Affiliation(s)
- Kathy Lynn Rush
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada
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Nawagi F, Söderberg M, Berggren V, Midlöv P, Ajambo A, Nakasujja N. Sociodemographic Characteristics and Health Profile of the Elderly Seeking Health Care in Kampala, Uganda. Curr Gerontol Geriatr Res 2018; 2018:4147509. [PMID: 29861722 PMCID: PMC5976942 DOI: 10.1155/2018/4147509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/11/2018] [Indexed: 12/14/2022] Open
Abstract
Aging entails health challenges globally, but pertinent data from low-income countries like Uganda remains scarce. A cross-sectional study was carried out at Mulago National Referral Hospital in Kampala, among 134 patients (38% men and 62% women) aged ≥60 years. Data was collected on sociodemographic characteristics, medical disorders, cognitive function, hearing handicap, and functional status, that is, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). The participants had high independency in BADL (89%) and IADL (75%). The most common medical conditions were bone/joint pain (35%), hypertension (24%), and visual problems (20%). More women (54%) than men (37%) reported bone and joint pain. The majority (80%) of the participants did not report any hearing handicap, and half (54%) did not have any cognitive impairment. Dependency in IADL was associated with advanced age, being female, and being financially dependent, and the risk of having a hearing handicap was higher among those above the median age (68 years). In adjusted models, the effects remained similar although statistical significance was only achieved for advanced age versus dependency in IADL (RR: 2.38, 95% CI: 1.12-5.08) and hearing handicap (RR: 2.67, 95% CI: 1.17-6.12). Thus, socioeconomic status and gender are relevant aspects when attempting to understand the health profile of the elderly in Kampala, Uganda.
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Affiliation(s)
- Faith Nawagi
- Euclid University Global Health Institute, Washington, DC, USA
| | - Martin Söderberg
- Faculty of Social Sciences, Child Rights Institute, Lund University, Lund, Sweden
| | - Vanja Berggren
- Research Group Clinical Health Promotion, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Lund University, Lund, Sweden
| | - Aidah Ajambo
- Makerere University-Johns Hopkins Research Collaboration, PMTCT Program, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
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Umuhoza SM, Ataguba JE. Inequalities in health and health risk factors in the Southern African Development Community: evidence from World Health Surveys. Int J Equity Health 2018; 17:52. [PMID: 29703215 PMCID: PMC5921793 DOI: 10.1186/s12939-018-0762-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background Socioeconomic inequalities in health have been documented in many countries including those in the Southern African Development Community (SADC). However, a comprehensive assessment of health inequalities and inequalities in the distribution of health risk factors is scarce. This study specifically investigates inequalities both in poor self-assessed health (SAH) and in the distribution of selected risk factors of ill-health among the adult populations in six SADC countries. Methods Data come from the 2002/04 World Health Survey (WHS) using six SADC countries (Malawi, Mauritius, South Africa, Swaziland, Zambia and Zimbabwe) where the WHS was conducted. Poor SAH is reporting bad or very bad health status. Risk factors such as smoking, heavy drinking, low fruit and vegetable consumption and physical inactivity were considered. Other environmental factors were also considered. Socioeconomic status was assessed using household expenditures. Standardised and normalised concentration indices (CIs) were used to assess socioeconomic inequalities. A positive (negative) concentration index means a pro-rich (pro-poor) distribution where the variable is reported more among the rich (poor). Results Generally, a pro-poor socioeconomic inequality exists in poor SAH in the six countries. However, this is only significant for South Africa (CI = − 0.0573; p < 0.05), and marginally significant for Zambia (CI = − 0.0341; P < 0.1) and Zimbabwe (CI = − 0.0357; p < 0.1). Smoking and inadequate fruit and vegetable consumption were significantly concentrated among the poor. Similarly, the use of biomass energy, unimproved water and sanitation were significantly concentrated among the poor. However, inequalities in heavy drinking and physical inactivity are mixed. Overall, a positive relationship exists between inequalities in ill-health and inequalities in risk factors of ill-health. Conclusion There is a need for concerted efforts to tackle the significant socioeconomic inequalities in ill-health and health risk factors in the region. Because some of the determinants of ill-health lie outside the health sector, inter-sectoral action is required.
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Affiliation(s)
- Stella M Umuhoza
- Department of Health Policy, Economics and Management, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
| | - John E Ataguba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
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Stockdale L, Nash S, Nalwoga A, Painter H, Asiki G, Fletcher H, Newton R. Human cytomegalovirus epidemiology and relationship to tuberculosis and cardiovascular disease risk factors in a rural Ugandan cohort. PLoS One 2018; 13:e0192086. [PMID: 29408860 PMCID: PMC5800673 DOI: 10.1371/journal.pone.0192086] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
Human cytomegalovirus (HCMV) infection has been associated with increased mortality, specifically cardiovascular disease (CVD), in high-income countries (HICs). There is a paucity of data in low- and middle-income countries (LMICs) where HCMV seropositivity is higher. Serum samples from 2,174 Ugandan individuals were investigated for HCMV antibodies and data linked to demographic information, co-infections and a variety of CVD measurements. HCMV seropositivity was 83% by one year of age, increasing to 95% by five years. Female sex, HIV positivity and active pulmonary tuberculosis (TB) were associated with an increase in HCMV IgG levels in adjusted analyses. There was no evidence of any associations with risk factors for CVD after adjusting for age and sex. HCMV infection is ubiquitous in this rural Ugandan cohort from a young age. The association between TB disease and high HCMV IgG levels merits further research. Known CVD risk factors do not appear to be associated with higher HCMV antibody levels in this Ugandan cohort.
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Affiliation(s)
- Lisa Stockdale
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom
| | - Angela Nalwoga
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Hannah Painter
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
| | - Gershim Asiki
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Helen Fletcher
- London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
- University of York, Department of Health Sciences, York, United Kingdom
- International Agency for Research on Cancer, Lyon, France
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Cham B, Scholes S, Ng Fat L, Badjie O, Mindell JS. Burden of hypertension in The Gambia: evidence from a national World Health Organization (WHO) STEP survey. Int J Epidemiol 2018; 47:860-871. [PMID: 29394353 DOI: 10.1093/ije/dyx279] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/04/2017] [Accepted: 01/15/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-communicable diseases are increasing in sub-Saharan Africa and are estimated to account for 32% of adult deaths in The Gambia. Worldwide, prevalence of hypertension is highest in the African region (46%) and a very high proportion is undiagnosed. This study examined diagnosed and undiagnosed hypertension in The Gambian adult population. METHODS Data were collected in 2010 from a nationally representative random sample of 4111 adults aged 25-64 years, using the World Health Organization STEPwise cross-sectional survey methods. Analyses were restricted to non-pregnant participants with three valid blood pressure measurements (n = 3573). We conducted gender-stratified univariate and multivariate regression analyses to identify the strongest sociodemographic, behavioural and biological risk factors associated with hypertension. RESULTS Almost one-third of adults were hypertensive; a high proportion were undiagnosed, particularly among men (86% of men vs 71% of women with hypertension, P < 0.001). Rural and semi-urban residents and overweight/obese persons had increased odds of hypertension. Compared with urban residents, participants from one of the most rural regions had higher odds of hypertension among both men [adjusted odds ratio (AOR) 3.2; 95% CI: 1.6-6.4] and women (AOR 2.5; 95% CI: 1.3-4.6). Other factors strongly associated with hypertension in multivariate analyses were age, smoking, physical inactivity and ethnicity. CONCLUSIONS Rural and semi-urban residence were strongly associated with hypertension, contrary to what has been found in similar studies in sub-Saharan Africa. Intervention to reduce the burden of hypertension in The Gambia could be further targeted towards rural areas.
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Affiliation(s)
- Bai Cham
- University College London, Department of Epidemiology and Public Health, London, UK.,University of The Gambia, Department of Public Health, Brikama Campus, P.O. Box 3530, Serrekunda, The Gambia and
| | - Shaun Scholes
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Linda Ng Fat
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Omar Badjie
- Non-Communicable Diseases Unit, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Jennifer S Mindell
- University College London, Department of Epidemiology and Public Health, London, UK
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Antignac M, Diop IB, Macquart de Terline D, Kramoh KE, Balde DM, Dzudie A, Ferreira B, Houenassi MD, Hounsou D, Ikama MS, Kane A, Kimbally-Kaki SG, Kingue S, Kouam Kouam C, Limbole E, Mfeukeu Kuate L, Mipinda JB, N'Guetta R, Nhavoto C, Sesso Z, Sidy Ali A, Ali Toure I, Plouin PF, Perier MC, Narayanan K, Empana JP, Jouven X. Socioeconomic Status and Hypertension Control in Sub-Saharan Africa: The Multination EIGHT Study (Evaluation of Hypertension in Sub-Saharan Africa). Hypertension 2018; 71:577-584. [PMID: 29378852 DOI: 10.1161/hypertensionaha.117.10512] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/13/2017] [Accepted: 01/09/2018] [Indexed: 12/15/2022]
Abstract
Systemic hypertension is a rapidly growing epidemic in Africa. The role of socioeconomic status on blood pressure control has not been well studied in this part of the world. We, therefore, aimed to quantify the association of socioeconomic status both at the individual and at the country level with blood pressure control in Sub-Saharan Africa. We conducted a cross-sectional survey in urban clinics of 12 countries, both low income and middle income, in Sub-Saharan Africa. Standardized blood pressure measures were made among the hypertensive patients attending the clinics. Blood pressure control was defined as blood pressure <140/90 mm Hg, and hypertension grades were defined according to the European Society of Cardiology guidelines. A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% men) were included. Uncontrolled hypertension was present in 1692 patients (77.4%), including 1044 (47.7%) with ≥grade 2 hypertension. The proportion of uncontrolled hypertension progressively increased with decreasing level of patient individual wealth, respectively, 72.8%, 79.3%, and 81.8% (P for trend, <0.01). Stratified analysis shows that these differences of uncontrolled hypertension according to individual wealth index were observed in low-income countries (P for trend, 0.03) and not in middle-income countries (P for trend, 0.26). In low-income countries, the odds of uncontrolled hypertension increased 1.37-fold (odds ratio, 1.37 [0.99-1.90]) and 1.88-fold (odds ratio, 1.88 [1.10-3.21]) in patients with middle and low individual wealth as compared with high individual wealth. Similarly, the grade of hypertension increased progressively with decreasing level of individual patient wealth (P for trend, <0.01). Strategies for hypertension control in Sub-Saharan Africa should especially focus on people in the lowest individual wealth groups who also reside in low-income countries.
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Affiliation(s)
- Marie Antignac
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.).
| | - Ibrahima Bara Diop
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Diane Macquart de Terline
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Kouadio Euloge Kramoh
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Dadhi M Balde
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Anastase Dzudie
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Beatriz Ferreira
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Martin Dèdonougbo Houenassi
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Dominique Hounsou
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Méo Stéphane Ikama
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Adama Kane
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Suzy Gisèle Kimbally-Kaki
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Samuel Kingue
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Charles Kouam Kouam
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Emmanuel Limbole
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Liliane Mfeukeu Kuate
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Jean Bruno Mipinda
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Roland N'Guetta
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Carol Nhavoto
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Zouwera Sesso
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Abdallahi Sidy Ali
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Ibrahim Ali Toure
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Pierre François Plouin
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Marie Cécile Perier
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Kumar Narayanan
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Jean Philippe Empana
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
| | - Xavier Jouven
- From the Department of Pharmacy, St Antoine hospital, HUEP (Hôpitaux Universitaires Est Parisien), AP-HP (Assistance Publique-Hôpitaux de Paris), France (M.A., D.M.d.T.); Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, France (M.A., D.M.d.T., P.F.P., M.C.P., J.P.E., X.J.); Department of Cardiology, University Hospital of Fann, Dakar, Senegal (I.B.D.); Paris Descartes University, France (D.M.d.T., P.F.P., X.J.); Institute of Cardiology of Abidjan, Ivory Coast, Abidjan, Cote d'Ivoire (K.E.K., R.N.); Department of Cardiology, University Hospital of Conakry, Guinea (D.M.B.); Cardiac Intensive Care and Cardiac Pacing Unit, Douala General Hospital, Cameroon (A.D.); Instituto do Coração, Maputo, Mozambic (B.F., C.N.); National University Hospital of Hubert K. Maga (CNHU-HKM), Cotonou, Bénin (M.D.H., D.H.); Department of Cardiology, National University Hospital of Brazzaville, Marien Ngouabi University, Congo (M.S.I., S.G.K.-K.); Department of Cardiology, University Hospital of Aristide Le Dantec, Dakar, Senegal (A.K.); University of Yaoundé, Ministry of Public Health, Cameroon (S.K., L.M.K.); Department of Internal Medicine, Régional Hospital, Bafoussam, Cameroon (C.K.K.); Department of Internal Medicine (CMCG), Ngaliema Hospital, la Gombe, Kinshasa, Democratic Republic of the Congo (E.L.); Central hospital of Yaoundé, Cameroon (L.M.K.); University Hospital of Libreville, Gabon (J.B.M.); Department of Cardiology, Lome, Togo (Z.S.); Cardiology Unit, National Hospital Center, Nouakchott, Mauritania (A.S.A.); Department of Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niger (I.A.T.); Department of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France (P.F.P., X.J.); and Maxcure Hospitals, Hyderabad, India (K.N.)
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Hyle EP, Mayosi BM, Middelkoop K, Mosepele M, Martey EB, Walensky RP, Bekker LG, Triant VA. The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review. BMC Public Health 2017; 17:954. [PMID: 29246206 PMCID: PMC5732372 DOI: 10.1186/s12889-017-4940-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022] Open
Abstract
Background Sub-Saharan Africa (SSA) has confronted decades of the HIV epidemic with substantial improvements in access to life-saving antiretroviral therapy (ART). Now, with improved survival, people living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs), including atherosclerotic cardiovascular disease (CVD). We assessed the existing literature regarding the association of CVD outcomes and HIV in SSA. Methods We used the PRISMA guidelines to perform a systematic review of the published literature regarding the association of CVD and HIV in SSA with a focus on CVD surrogate and clinical outcomes in PLWH. Results From January 2000 until March 2017, 31 articles were published regarding CVD outcomes among PLWH in SSA. Data from surrogate CVD outcomes (n = 13) suggest an increased risk of CVD events among PLWH in SSA. Although acute coronary syndrome is reported infrequently in SSA among PLWH, limited data from five studies suggest extensive thrombus and hypercoagulability as contributing factors. Additional studies suggest an increased risk of stroke among PLWH (n = 13); however, most data are from immunosuppressed ART-naïve PLWH and thus are potentially confounded by the possibility of central nervous system infections. Conclusions Given ongoing gaps in our current understanding of CVD and other NCDs in PLWH in SSA, it is imperative to ascertain the burden of CVD outcomes, and to examine strategies for intervention and best practices to enhance the health of this vulnerable population. Electronic supplementary material The online version of this article (10.1186/s12889-017-4940-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA. .,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Bongani M Mayosi
- Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Keren Middelkoop
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Mosepele Mosepele
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Botswana-Harvard AIDS Partnership, Gaborone, Botswana
| | - Emily B Martey
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Virginia A Triant
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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32
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Kien VD, Minh HV, Ngoc NB, Phuong TB, Ngan TT, Quam MB. Inequalities in Household Catastrophic Health Expenditure and Impoverishment Associated With Noncommunicable Diseases in Chi Linh, Hai Duong, Vietnam. Asia Pac J Public Health 2017; 29:35S-44S. [PMID: 28719772 DOI: 10.1177/1010539517712919] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A costly modern-day double burden, the expenses of noncommunicable diseases (NCDs) are becoming a devastating epidemic. The World Health Organization estimates $7 trillion in economic losses from NCDs in 2011-2025. Although regarded as affluent diseases, the burden of NCDs is shifting into poorer groups. In this study, we assessed the socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with NCDs in Northern Vietnam. We also identified associated factors for catastrophic health expenditure and impoverishment. Households self-reporting NCD diagnoses had the highest association with both catastrophic health expenditure and impoverishment, followed by those in urban areas. Such households were likely poorer according to our calculations estimating socioeconomic inequalities. Households with at least 1 member older than 60 years were also more likely to suffer catastrophic health expenditures. These findings suggest that targeted policy to prevent or subsidize care for NCDs could prevent catastrophic health expenditure and impoverishment among those already most disadvantaged.
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Affiliation(s)
- Vu Duy Kien
- 1 Hanoi University of Public Health, Hanoi, Vietnam
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33
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Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, Levitt NS, Mangugu FW, Nyirenda MJ, Ogle GD, Ramaiya K, Sewankambo NK, Sobngwi E, Tesfaye S, Yudkin JS, Basu S, Bommer C, Heesemann E, Manne-Goehler J, Postolovska I, Sagalova V, Vollmer S, Abbas ZG, Ammon B, Angamo MT, Annamreddi A, Awasthi A, Besançon S, Bhadriraju S, Binagwaho A, Burgess PI, Burton MJ, Chai J, Chilunga FP, Chipendo P, Conn A, Joel DR, Eagan AW, Gishoma C, Ho J, Jong S, Kakarmath SS, Khan Y, Kharel R, Kyle MA, Lee SC, Lichtman A, Malm CP, Mbaye MN, Muhimpundu MA, Mwagomba BM, Mwangi KJ, Nair M, Niyonsenga SP, Njuguna B, Okafor OLO, Okunade O, Park PH, Pastakia SD, Pekny C, Reja A, Rotimi CN, Rwunganira S, Sando D, Sarriera G, Sharma A, Sidibe A, Siraj ES, Syed AS, Van Acker K, Werfalli M. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol 2017; 5:622-667. [PMID: 28688818 DOI: 10.1016/s2213-8587(17)30181-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Justine I Davies
- Centre for Global Health, King's College London, Weston Education Centre, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa
| | | | - Till Bärnighausen
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute, KwaZulu, South Africa
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine & Endocrinology, University of Cape Town, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Moffat J Nyirenda
- Department of NCD Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; NCD Theme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW, Australia; Diabetes NSW & ACT, Glebe, NSW, Australia
| | | | - Nelson K Sewankambo
- Department of Medicine, and Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eugene Sobngwi
- University of Newcastle at Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Solomon Tesfaye
- Sheffield Teaching Hospitals and University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Sanjay Basu
- Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Christian Bommer
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Esther Heesemann
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Jennifer Manne-Goehler
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iryna Postolovska
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Vera Sagalova
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Sebastian Vollmer
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania
| | - Benjamin Ammon
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akhila Annamreddi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ananya Awasthi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Agnes Binagwaho
- Harvard Medical School, Harvard University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; University of Global Health Equity, Kigali, Rwanda
| | | | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeanne Chai
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Felix P Chilunga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Anna Conn
- The Fletcher School of Law and Diplomacy, Tufts University, Medford, MA, USA
| | - Dipesalema R Joel
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Arielle W Eagan
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Julius Ho
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simcha Jong
- Leiden University, Science Based Business, Leiden, Netherlands
| | - Sujay S Kakarmath
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Ramu Kharel
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Kyle
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Seitetz C Lee
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amos Lichtman
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Maïmouna N Mbaye
- Clinique Médicale II, Centre de diabétologie Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal
| | - Marie A Muhimpundu
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Mohit Nair
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simon P Niyonsenga
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Obiageli L O Okafor
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Oluwakemi Okunade
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul H Park
- Partners In Health, Rwinkwavu, South Kayonza, Rwanda
| | - Sonak D Pastakia
- Purdue University College of Pharmacy (Purdue Kenya Partnership), Indiana Institute for Global Health, Uasin Gishu, Kenya
| | | | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Rwunganira
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - David Sando
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anshuman Sharma
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Azhra S Syed
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristien Van Acker
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mahmoud Werfalli
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Owolabi EO, Goon DT, Adeniyi OV, Seekoe E. Social epidemiology of hypertension in Buffalo City Metropolitan Municipality (BCMM): cross-sectional study of determinants of prevalence, awareness, treatment and control among South African adults. BMJ Open 2017; 7:e014349. [PMID: 28600362 PMCID: PMC5623394 DOI: 10.1136/bmjopen-2016-014349] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study examined hypertension prevalence, awareness, treatment and control and their determinants among adults attending health facilities in Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape. DESIGN A cross-sectional analytical study. SETTINGS The three largest outpatient clinics in BCMM. PARTICIPANTS Ambulatory adults (aged 18 years and over) attending the study settings during the study period (n=998). PRIMARY OUTCOME MEASURE The prevalence of hypertension (systolic blood pressure (BP) of ≥140 mm Hg and/or a diastolic BP of ≥90 mm Hg or current medication for hypertension), the awareness of it (prior diagnosis of it) and its treatment and control (Eighth Joint National Committee Criteria of BP <140/90/90 mm Hg). SECONDARY OUTCOME MEASURE Associated factors of hypertension, hypertension unawareness and uncontrolled hypertension. RESULTS Of the 998 participants included, the prevalence of hypertension was 49.2%. Hypertension unawareness was reported by 152 participants (23.1%) with significant gender difference (p=0.005). Male sex, age <45 years, higher level of education, single status, current employment, higher monthly income, current smoking, alcohol usage, absence of diabetes and non-obese were significantly associated (p<0.05) with hypertension unawareness.Of the participants who were aware of having hypertension (n=339), nearly all (91.7%, n=311) were on antihypertensive medication and only 121 participants (38.9%) achieved the BP treatment target. In the multivariate logistic regression model analysis, ageing (95% CI 1.9 to 4.4), being married (95% CI 1.0 to 2.0), male sex (95% CI 1.2 to 2.3), concomitant diabetes (95% CI 1.9 to 3.9), lower monthly income (95% CI 1.2 to 2.2), being unemployed (95% CI 1.0 to 1.9) and central obesity (95% CI 1.5 to 2.8) were the significant and independent determinants of prevalent hypertension. CONCLUSION The prevalence and awareness of hypertension was high in the study population. In addition, the suboptimal control of BP among treated individuals, as well as the significant cardiovascular risk factors, warrant the attention of health authorities of BCMM and the country.
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Affiliation(s)
- Eyitayo Omolara Owolabi
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Daniel Ter Goon
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Faculty of Health Sciences, Walter Sisulu University/Cecilia Makiwane Hospital, East London Hospital Complex, East London, South Africa
| | - Eunice Seekoe
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa
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Kazooba P, Kasamba I, Mayanja BN, Lutaakome J, Namakoola I, Salome T, Kaleebu P, Munderi P. Cardiometabolic risk among HIV-POSITIVE Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy. Pan Afr Med J 2017; 27:40. [PMID: 28761616 PMCID: PMC5516660 DOI: 10.11604/pamj.2017.27.40.9840] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/10/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION We investigated the prevalence, predictors of and effect of Antiretroviral Therapy (ART) regimen on cardiometabolic risk among HIV-positive Ugandan adults at enrolment into a prospective cohort to study the Complications of Long-Term ART (CoLTART). METHODS We collected data on cardiometabolic risk factors including dyslipidemia, hypertension, hyperglycemia, obesity and calculated the mean atherogenic index for Plasma (AIP) and 10 year Framingham risk score (FHS). Exposures were: ART regimen, duration on ART, demographic, socio-economic, behavioral, and life-style factors including smoking, physical activity and diet (including fruit and vegetables consumption). RESULTS We enrolled 1024 participants, 65% female, mean age was 44.8 years (SD 8.0) and median duration on ART was 9.4 years (IQR 6.1-9.8). The prevalence of abdominal obesity was 52.6%, BMI≥25 kg/m2 -26.1%, hypertension-22.6%, high AIP-31.3% and FHS above 10% was 16.6%. The prevalence of low High Density Lipoprotein (HDL) was 37.5%, high Total cholesterol (Tc)-30.2%, high Low Density Lipoprotein (LDL) -23.6%, high Triglycerides (TG)-21.2%, low physical activity-46.4% and alcohol consumption-26.4%. In multivariate linear regression analyses, increasing age was associated with higher mean Tc, HDL, LDL, FHS (P<0.001) and hyperglycemia (p<0.005). In multivariate logistic regression analyses, Protease Inhibitor (PI) containing regimens were significantly associated with higher risks of abnormal: Tc, LDL, TG, AIP, abdominal obesity, hypertension, low HDL and lower risk of a FHS >10% compared to the non PI regimen. CONCLUSION ART increases cardiometabolic risk. Integration of routine assessment for cardiometabolic risk factors and preventive interventions into HIV care programs in resource-limited settings is recommended.
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Affiliation(s)
- Patrick Kazooba
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Ivan Kasamba
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Joseph Lutaakome
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Ivan Namakoola
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Tino Salome
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - Pontiano Kaleebu
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Paula Munderi
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
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Luna M, Chen D, Rivera-Andrade Á, González J, Burt D, Mendoza-Montano C, Patrie J. Prevalence of risk factors for noncommunicable diseases in an indigenous community in Santiago Atitlán, Guatemala. Rev Panam Salud Publica 2017. [PMID: 28444007 PMCID: PMC6660872 DOI: 10.26633/rpsp.2017.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective. To describe the prevalence of noncommunicable disease (NCD) risk factors and assess knowledge of those risk factors in the indigenous community of Santiago Atitlán in Guatemala, a lower-middle income country. Methods. A population-based, cross-sectional study was conducted using a modified version of the World Health Organization’s STEPS protocol. Adults aged 20–65 years were surveyed regarding demographics and NCD risk factors, and the survey was followed by anthropometric and biochemical measurements. Results. Out of 501 screened individuals, 350 respondents were enrolled. The mean age was 36.7 years, and 72.3% were women. Over 90% reported earning less than US$ 65 per month. Almost 80% were stunted. Among women, 37.3% were obese and over three-quarters had central obesity. Over three-quarters of the entire group had dyslipidemia and 18.3% had hypertension, but only 3.0% had diabetes. Overall, 36.0% of participants met criteria for metabolic syndrome. There was no significant association between participants’ education and NCD risk factors except for an inverse association with obesity by percent body fat. Conclusions. Santiago Atitlán is a rural, indigenous Guatemalan community with high rates of poverty and stunting coexisting alongside high rates of obesity, particularly among women. Additionally, high rates of hypertension and dyslipidemia were found, but a low rate of diabetes mellitus. Knowledge of NCDs and their risk factors was low, suggesting that educational interventions may be a high-yield, low-cost approach to combating NCDs in this community.
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Affiliation(s)
- Max Luna
- Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - David Chen
- University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | | | - Jessica González
- University of Virginia–Guatemala Initiative, Quetzaltenango, Guatemala
| | - David Burt
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | | | - James Patrie
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
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Abstract
The theory of social gradient in health posits that individuals with lower socioeconomic status (SES) have poorer health outcomes, compared with those in higher socioeconomic brackets. Applied to noncommunicable diseases (NCDs), this theory has largely been corroborated by studies from the West. However, evidence from sub-Saharan Africa are mixed, with those from Ghana conspicuously missing in the literature. Using data from the Study on Global Ageing and Adult Health, and applying random-effects C log-log models, this study examined the relationship between SES and the risks of living with NCDs in Ghana. Results confirmed a negative social gradient, as Ghanaians with higher SES were more likely to live with NCDs compared with those with low SES. The addition of lifestyle factors attenuated the risks of living with NCDs among Ghanaian men and women with higher SES. This study underscores the need for policies targeted at specific socioeconomic and demographic groups, such as the emerging middle and upper class Ghanaians. It is similarly important for interventions to move beyond biomedical solutions that put more emphasis on epidemiological risk factors to strategies that embrace psychosocial factors as important correlates of cardiovascular health.
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Affiliation(s)
- Eric Y Tenkorang
- Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Wesonga R, Guwatudde D, Bahendeka SK, Mutungi G, Nabugoomu F, Muwonge J. Burden of cumulative risk factors associated with non-communicable diseases among adults in Uganda: evidence from a national baseline survey. Int J Equity Health 2016; 15:195. [PMID: 27905949 PMCID: PMC5133748 DOI: 10.1186/s12939-016-0486-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/25/2016] [Indexed: 12/20/2022] Open
Abstract
Background Modification of known risk factors has been the most tested strategy for dealing with non-communicable diseases (NCDs). The cumulative number of NCD risk factors exhibited by an individual depicts a disease burden. However, understanding the risk factors associated with increased NCD burden has been constrained by scarcity of nationally representative data, especially in the developing countries and not well explored in the developed countries as well. Methods Assessment of key risk factors for NCDs using population data drawn from 3987 participants in a nationally representative baseline survey in Uganda was made. Five key risk factors considered for the indicator variable included: high frequency of tobacco smoking, less than five servings of fruit and vegetables per day, low physical activity levels, high body mass index and raised blood pressure. We developed a composite indicator dependent variable with counts of number of risk factors associated with NCDs per participant. A statistical modeling framework was developed and a multinomial logistic regression model was fitted. The endogenous and exogenous predictors of NCD cumulative risk factors were assessed. Results A novel model framework for cumulative number of NCD risk factors was developed. Most respondents, 38 · 6% exhibited one or two NCD risk factors each. Of the total sample, 56 · 4% had at least two risk factors whereas only 5.3% showed no risk factor at all. Body mass index, systolic blood pressure, diastolic blood pressure, consumption of fruit and vegetables, age, region, residence, type of residence and land tenure system were statistically significant predictors of number of NCD risk factors (p < 0 · 05). With exception to diastolic blood pressure, increase in age, body mass index, systolic blood pressure and reduction in daily fruit and vegetable servings were found to significantly increase the relative risks of exhibiting cumulative NCD risk factors. Compared to the urban residence status, the relative risk of living in a rural area significantly increased the risk of having 1 or 2 risk factors by a multiple of 1.55. Conclusions The non-communicable disease burden is on the increase, with more participants reporting to have at least two risk factors. Our findings imply that, besides endogenous factors, exogenous factors such as region, residence status, land tenure system and behavioral characteristics have significant causal effects on the cumulative NCD risk factors. Subsequently, while developing interventions to combat cumulative risk factors of NCDs, the Ministry of Health needs to employ a more holistic approach to facilitate equitable health and sensitization across age, residence and regional divide.
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Affiliation(s)
- Ronald Wesonga
- School of Statistics and Planning, Makerere University, Kampala, Uganda. .,East African Statistics Institute, Kampala, East Africa, Uganda.
| | - David Guwatudde
- School of Public Health, Makerere University, Kampala, Uganda
| | - Silver K Bahendeka
- Department of Internal Medicine St. Francis Hospital Nsambya, Kampala, Uganda
| | - Gerald Mutungi
- Control of Non-communicable Diseases Desk, Ministry of Health, Kampala, Uganda
| | - Fabian Nabugoomu
- Office of DVC, Kyambogo University, Kampala, Uganda.,East African Statistics Institute, Kampala, East Africa, Uganda
| | - James Muwonge
- Division of Socioeconomic Surveys, Uganda Bureau of Statistics, Kampala, Uganda
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Barr AL, Young EH, Smeeth L, Newton R, Seeley J, Ripullone K, Hird TR, Thornton JRM, Nyirenda MJ, Kapiga S, Adebamowo CA, Amoah AG, Wareham N, Rotimi CN, Levitt NS, Ramaiya K, Hennig BJ, Mbanya JC, Tollman S, Motala AA, Kaleebu P, Sandhu MS. The need for an integrated approach for chronic disease research and care in Africa. Glob Health Epidemiol Genom 2016; 1:e19. [PMID: 29868211 PMCID: PMC5870416 DOI: 10.1017/gheg.2016.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/09/2016] [Accepted: 09/11/2016] [Indexed: 02/06/2023] Open
Abstract
With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa.
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Affiliation(s)
- A. L. Barr
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - E. H. Young
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - L. Smeeth
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - R. Newton
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
| | - J. Seeley
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - K. Ripullone
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - T. R. Hird
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - J. R. M. Thornton
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - M. J. Nyirenda
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - S. Kapiga
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - C. A. Adebamowo
- Department of Epidemiology and Public Health, Greenebaum Comprehensive Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore MD 21201 USA
- Institute of Human Virology, Nigeria
| | - A. G. Amoah
- Department of Medicine, University of Ghana Medical School, Korlebu, Ghana
| | - N. Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - C. N. Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - N. S. Levitt
- Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - K. Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - B. J. Hennig
- MRC Unit, The Gambia, Fajara, The Gambia
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - J. C. Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - S. Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - A. A. Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - P. Kaleebu
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
| | - M. S. Sandhu
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
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Quispe R, Benziger CP, Bazo-Alvarez JC, Howe LD, Checkley W, Gilman RH, Smeeth L, Bernabé-Ortiz A, Miranda JJ. The Relationship Between Socioeconomic Status and CV Risk Factors: The CRONICAS Cohort Study of Peruvian Adults. Glob Heart 2016; 11:121-130.e2. [PMID: 27102029 PMCID: PMC4838671 DOI: 10.1016/j.gheart.2015.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Variations in the distribution of cardiovascular disease and risk factors by socioeconomic status (SES) have been described in affluent societies, yet a better understanding of these patterns is needed for most low- and middle-income countries. OBJECTIVE This study sought to describe the relationship between cardiovascular risk factors and SES using monthly family income, educational attainment, and assets index, in 4 Peruvian sites. METHODS Baseline data from an age- and sex-stratified random sample of participants, ages ≥35 years, from 4 Peruvian sites (CRONICAS Cohort Study, 2010) were used. The SES indicators considered were monthly family income (n = 3,220), educational attainment (n = 3,598), and assets index (n = 3,601). Behavioral risk factors included current tobacco use, alcohol drinking, physical activity, daily intake of fruits and vegetables, and no control of salt intake. Cardiometabolic risk factors included obesity, elevated waist circumference, hypertension, insulin resistance, diabetes mellitus, low high-density lipoprotein cholesterol, and high triglyceride levels. RESULTS In the overall population, 41.6% reported a monthly family income CONCLUSIONS The association between SES and cardiometabolic risk factors varies depending on the SES indicator used. These results highlight the need to contextualize risk factors by socioeconomic groups in Latin American settings.
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Affiliation(s)
- Renato Quispe
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Catherine P Benziger
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Juan Carlos Bazo-Alvarez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - William Checkley
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care, School of Medicine Johns Hopkins University, Baltimore, MD, USA
| | - Robert H Gilman
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Asociación Benéfica PRISMA, Lima, Peru
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Nyombi KV, Kizito S, Mukunya D, Nabukalu A, Bukama M, Lunyera J, Asiimwe M, Kimuli I, Kalyesubula R. High prevalence of hypertension and cardiovascular disease risk factors among medical students at Makerere University College of Health Sciences, Kampala, Uganda. BMC Res Notes 2016; 9:110. [PMID: 26887672 PMCID: PMC4756514 DOI: 10.1186/s13104-016-1924-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 02/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background Cardiovascular disease has become a leading global health challenge representing the largest cause of mortality in adults worldwide. Non communicable diseases are neglected in Uganda over infectious diseases. With increased urbanization, there is likely increase in burden of these NCDs yet there is paucity of reliable data regarding the NCD burden. We assessed the prevalence of hypertension and other cardiovascular disease risk factors among medical students at Makerere University, College of Health Sciences in Kampala, Uganda. Methods We conducted a cross-sectional study at Makerere University comprising 180 medical students. We used a standardized questionnaire and anthropometric measurements to assess their cardiovascular disease risk factors using JNC-7. Logistic regression was used to assess factors associated with elevated blood pressure. Results Of the 180 students surveyed, 107 (59 %) were males, mean age was 22 years (SD = 3 years), and 159 (88 %) were in their preclinical years of training. Cardiovascular risk factors with the highest prevalence were alcohol consumption (31.7 %); elevated systolic blood pressure (14 %); and excessive salt intake (13 %). Participants with elevated systolic blood pressure were more likely to be older (OR = 1.18), overweight (OR = 1.08), and with a personal history of cardiovascular disease (OR = 4.68). Conclusions The prevalence of hypertension and known cardiovascular disease risk factors is high among the medical students. Strategies to prevent cardiovascular disease among the young population should be put in place.
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Affiliation(s)
- Kenneth V Nyombi
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Samuel Kizito
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - David Mukunya
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Angella Nabukalu
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Martin Bukama
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Joseph Lunyera
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Martha Asiimwe
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Ivan Kimuli
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Robert Kalyesubula
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
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El-Sayed AM, Palma A, Freedman LP, Kruk ME. Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries. Health Policy 2015; 119:1164-75. [PMID: 26271138 DOI: 10.1016/j.healthpol.2015.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 07/08/2015] [Accepted: 07/18/2015] [Indexed: 01/22/2023]
Abstract
Non-communicable diseases (NCDs) are the greatest contributor to morbidity and mortality in low- and middle-income countries (LMICs). However, NCD care is limited in LMICs, particularly among the disadvantaged and rural. We explored the role of insurance in mitigating socioeconomic and urban-rural disparities in NCD treatment across 48 LMICs included in the 2002-2004 World Health Survey (WHS). We analyzed data about ever having received treatment for diagnosed high-burden NCDs (any diagnosis, angina, asthma, depression, arthritis, schizophrenia, or diabetes) or having sold or borrowed to pay for healthcare. We fit multivariable regression models of each outcome by the interaction between insurance coverage and household wealth (richest 20% vs. poorest 50%) and urbanicity, respectively. We found that insurance was associated with higher treatment likelihood for NCDs in LMICs, and helped mitigate socioeconomic and regional disparities in treatment likelihood. These influences were particularly strong among women. Insurance also predicted lower likelihood of borrowing or selling to pay for health services among the poorest women. Taken together, insurance coverage may serve as an important policy tool in promoting NCD treatment and in reducing inequities in NCD treatment by household wealth, urbanicity, and sex in LMICs.
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Affiliation(s)
- Abdulrahman M El-Sayed
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
| | - Anton Palma
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Lynn P Freedman
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Margaret E Kruk
- Department of Global Health & Population, Chan School of Public Health, Harvard University, 665 Huntington Ave., Rm 1115, Boston, MA 02115, USA
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Wandera SO, Kwagala B, Ntozi J. Prevalence and risk factors for self-reported non-communicable diseases among older Ugandans: a cross-sectional study. Glob Health Action 2015. [PMID: 26205363 PMCID: PMC4513181 DOI: 10.3402/gha.v8.27923] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There is limited evidence about the prevalence and risk factors for non-communicable diseases (NCDs) among older Ugandans. Therefore, this article is aimed at investigating the prevalence of self-reported NCDs and their associated risk factors using a nationally representative sample. Design We conducted a secondary analysis of the 2010 Uganda National Household Survey (UNHS) using a weighted sample of 2,382 older people. Frequency distributions for descriptive statistics and Pearson chi-square tests to identify the association between self-reported NCDs and selected explanatory variables were done. Finally, multivariable complementary log–log regressions to estimate the risk factors for self-reported NCDs among older people in Uganda were done. Results About 2 in 10 (23%) older persons reported at least one NCD [including hypertension (16%), diabetes (3%), and heart disease (9%)]. Among all older people, reporting NCDs was higher among those aged 60–69 and 70–79; Muslims; and Pentecostals and Seventh Day Adventists (SDAs). In addition, the likelihood of reporting NCDs was higher among older persons who depended on remittances and earned wages; owned a bicycle; were sick in the last 30 days; were disabled; and were women. Conversely, the odds of reporting NCDs were lower for those who were relatives of household heads and were poor. Conclusions In Uganda, self-reported NCDs were associated with advanced age, being a woman, having a disability, ill health in the past 30 days, being rich, depended on remittances and earning wages, being Muslim, Pentecostal and SDAs, and household headship. The Ministry of Health should prevent and manage NCDs by creating awareness in the public and improving the supply of essential drugs for these health conditions. Finally, there is a need for specialised surveillance studies of older people to monitor the trends and patterns of NCDs over time.
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Affiliation(s)
- Stephen Ojiambo Wandera
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda;
| | - Betty Kwagala
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - James Ntozi
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
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Brathwaite R, Addo J, Smeeth L, Lock K. A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014. PLoS One 2015; 10:e0132401. [PMID: 26162085 DOI: 10.1371/journal.pone.0132401] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 06/14/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To systematically review current smoking prevalence among adults in sub-Saharan Africa from 2007 to May 2014 and to describe the context of tobacco control strategies in these countries. Data Sources Five databases, Medline, Embase, Africa-wide Information, Cinahl Plus, and Global Health were searched using a systematic search strategy. There were no language restrictions. Study Selection 26 included studies measured current smoking prevalence in nationally representative adult populations in sub-Saharan African countries. Data Extraction Study details were independently extracted using a standard datasheet. Data on tobacco control policies, taxation and trends in prices were obtained from the Implementation Database of the WHO FCTC website. Results Studies represented 13 countries. Current smoking prevalence varied widely ranging from 1.8% in Zambia to 25.8% in Sierra Leone. The prevalence of smoking was consistently lower in women compared to men with the widest gender difference observed in Malawi (men 25.9%, women 2.9%). Rwanda had the highest prevalence of women smokers (12.6%) and Ghana had the lowest (0.2%). Rural, urban patterns were inconsistent. Most countries have implemented demand-reduction measures including bans on advertising, and taxation rates but to different extents. Conclusion Smoking prevalence varied widely across sub-Saharan Africa, even between similar country regions, but was always higher in men. High smoking rates were observed among countries in the eastern and southern regions of Africa, mainly among men in Ethiopia, Malawi, Rwanda, and Zambia and women in Rwanda and rural Zambia. Effective action to reduce smoking across sub-Saharan Africa, particularly targeting population groups at increased risk remains a pressing public health priority.
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Asiki G, Murphy GA, Baisley K, Nsubuga RN, Karabarinde A, Newton R, Seeley J, Young EH, Kamali A, Sandhu MS. Prevalence of dyslipidaemia and associated risk factors in a rural population in South-Western Uganda: a community based survey. PLoS One 2015; 10:e0126166. [PMID: 25974077 DOI: 10.1371/journal.pone.0126166] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 11/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden of dyslipidaemia is rising in many low income countries. However, there are few data on the prevalence of, or risk factors for, dyslipidaemia in Africa. METHODS In 2011, we used the WHO Stepwise approach to collect cardiovascular risk data within a general population cohort in rural south-western Uganda. Dyslipidaemia was defined by high total cholesterol (TC) ≥ 5.2 mmol/L or low high density lipoprotein cholesterol (HDL-C) <1 mmol/L in men, and <1.3 mmol/L in women. Logistic regression was used to explore correlates of dyslipidaemia. RESULTS Low HDL-C prevalence was 71.3% and high TC was 6.0%. In multivariate analysis, factors independently associated with low HDL-C among both men and women were: decreasing age, tribe (prevalence highest among Rwandese tribe), lower education, alcohol consumption (comparing current drinkers to never drinkers: men adjusted (a)OR=0.44, 95%CI=0.35-0.55; women aOR=0.51, 95%CI=0.41-0.64), consuming <5 servings of fruit/vegetable per day, daily vigorous physical activity (comparing those with none vs those with 5 days a week: men aOR=0.83 95%CI=0.67-1.02; women aOR=0.76, 95%CI=0.55-0.99), blood pressure (comparing those with hypertension to those with normal blood pressure: men aOR=0.57, 95%CI=0.43-0.75; women aOR=0.69, 95%CI=0.52-0.93) and HIV infection (HIV infected without ART vs. HIV negative: men aOR=2.45, 95%CI=1.53-3.94; women aOR=1.88, 95%CI=1.19-2.97). The odds of low HDL-C was also higher among men with high BMI or HbA1c ≤ 6%, and women who were single or with abdominal obesity. Among both men and women, high TC was independently associated with increasing age, non-Rwandese tribe, high waist circumference (men aOR=5.70, 95%CI=1.97-16.49; women aOR=1.58, 95%CI=1.10-2.28), hypertension (men aOR=3.49, 95%CI=1.74-7.00; women aOR=1.47, 95%CI=0.96-2.23) and HbA1c >6% (men aOR=3.00, 95%CI=1.37-6.59; women aOR=2.74, 95%CI=1.77-4.27). The odds of high TC was also higher among married men, and women with higher education or high BMI. CONCLUSION Low HDL-C prevalence in this relatively young rural population is high whereas high TC prevalence is low. The consequences of dyslipidaemia in African populations remain unclear and prospective follow-up is required.
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Asiki G, Baisley K, Kamali A, Kaleebu P, Seeley J, Newton R. A prospective study of trends in consumption of cigarettes and alcohol among adults in a rural Ugandan population cohort, 1994-2011. Trop Med Int Health 2015; 20:527-36. [PMID: 25496206 DOI: 10.1111/tmi.12451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To characterise trends over time in smoking and alcohol consumption in a rural Ugandan population between 1994 and 2011. METHODS We used self-reported data from a long-standing population cohort - the General Population Cohort. From 1989 to 1999, the study population comprised about 10 000 residents of 15 adjacent villages. From 1999, 10 more villages were added, doubling the population. Among adults (≥13 years, who comprise about half of the total study population), data on smoking were collected in 1994/1995, 2008/2009 and in 2010/2011. Data on alcohol were collected in 1996/1997, 2000/2001, 2009/2010 and 2010/2011. RESULTS The reported prevalence of smoking among men was 17% in 1994/1995, 14% in 2008/2009 and 16% in 2010/2011; equivalent figures for women were 1.5%, 1% and 2%. In the most recent time period, for both sexes combined, prevalence of smoking increased from 1.5% in those aged <29 years, to 18% in those 50+ years (P < 0.001); prevalence was 14.8% in the lowest tertile of socio-economic status, decreasing to 3.7% in the highest (P < 0.001). For alcohol consumption, current drinking was reported by 39% in 1996/1997, 35% in 2000/2001 and 28% in 2010/2011; men were more likely to drink than women (32.9% vs. 23.5% in 2010/2011) and consumption increased with age (P < 0.001); and was associated with low socio-economic status, riskier sexual behaviour and being HIV positive (P < 0.001). CONCLUSIONS In this rural Ugandan population, consumption of cigarettes and alcohol is higher among men than women, increases with age and is more frequent among those with low socio-economic status. We find no evidence of increases in either exposure over time.
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Affiliation(s)
- Gershim Asiki
- Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
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Kidy F, Rutebarika D, Lule SA, Kizza M, Odiit A, Webb EL, Elliott AM. Blood pressure in primary school children in Uganda: a cross-sectional survey. BMC Public Health 2014; 14:1223. [PMID: 25427456 PMCID: PMC4289384 DOI: 10.1186/1471-2458-14-1223] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background Non-communicable diseases are an emerging concern in sub-Saharan Africa, and risks for these conditions are often based on exposures in early life, with premonitory signs developing during childhood. The prevalence of hypertension has been reported to be high in African adults, but little is known about blood pressure in African children. We studied prevalence and risk factors for high blood pressure (HBP) among school children in central Uganda. Methods Two urban and five rural schools were randomly selected from government schools in Wakiso district, Uganda. Questionnaires were administered and anthropometric measures taken. Blood pressure (BP) was measured three times in one sitting (on day 1) and the average compared to internationally-used normograms. Children with BP >95th percentile were re-tested at two additional sittings (day 2 and day 3) within one week, and at two further follow up visits over a period of six months. Those with sustained HBP were referred for further investigation. Results Of 552 students included, 539 completed the initial assessments (days 1–3) of whom 92 (17.1%) had HBP at the initial sitting. Age (adjusted odds ratio (aOR) 1.29 (95% confidence interval 1.14, 1.47), p< 0.001), body mass index (1.70 (1.25-2.31) p = 0.001) and soil-transmitted helminths (2.52 (1.04-6.11), 0.04) were associated with increased prevalence of HBP at the initial sitting. After further investigation, sustained HBP was seen in 14 children, yielding an estimated prevalence of 3.8% allowing for losses to follow up. Four children required treatment. Conclusion It is feasible to measure blood pressure accurately in the school setting. A high HBP prevalence on initial readings gave cause for concern, but follow up suggested a true HBP prevalence commensurate with international normograms. Extended follow up is important for accurate assessment of blood pressure among African children.
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Affiliation(s)
| | | | | | | | | | | | - Alison M Elliott
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Kaleebu P, Kamali A, Seeley J, Elliott AM, Katongole-Mbidde E. The Medical Research Council (UK)/Uganda Virus Research Institute Uganda Research Unit on AIDS--'25 years of research through partnerships'. Trop Med Int Health 2014; 20:E1-10. [PMID: 25354929 PMCID: PMC4529486 DOI: 10.1111/tmi.12415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
For the past 25 years, the Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS has conducted research on HIV-1, coinfections and, more recently, on non-communicable diseases. Working with various partners, the research findings of the Unit have contributed to the understanding and control of the HIV epidemic both in Uganda and globally, and informed the future development of biomedical HIV interventions, health policy and practice. In this report, as we celebrate our silver jubilee, we describe some of these achievements and the Unit's multidisciplinary approach to research. We also discuss the future direction of the Unit; an exemplar of a partnership that has been largely funded from the north but led in the south.
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Affiliation(s)
- P Kaleebu
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Entebbe, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, UK
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Janković S, Stojisavljević D, Janković J, Erić M, Marinković J. Association of socioeconomic status measured by education, and cardiovascular health: a population-based cross-sectional study. BMJ Open 2014; 4:e005222. [PMID: 25031193 PMCID: PMC4120304 DOI: 10.1136/bmjopen-2014-005222] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Cardiovascular health (CVH) is a relatively new concept defined by the American Heart Association (AHA). The aim of the present study was to assess whether the indices of CVH were discriminators of socioeconomic status (SES) in the adult population of the Republic of Srpska (RS). DESIGN Population-based cross-sectional study. SETTING RS, Bosnia and Herzegovina. PARTICIPANTS The study involved 4165 adults aged ≥18 years (mean age 50.2; 54% women) who participated in the National Health Survey performed from September to November 2010 in the RS. STUDY VARIABLES Participant's education was a proxy for SES. Potential discriminators of SES were indices of CVH presented according to AHA as: ideal health behaviours index (non-smoking, body mass index <25 kg/m(2), physical activity at goal level and healthy diet); ideal health factors index (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, untreated fasting glucose <100 mg/dL and non-smoking); and ideal CVH status (defined as all seven ideal health metrics present) versus intermediate and poor CVH status. RESULTS Participants with high educational levels had a significantly greater number of ideal CVH metrics, and ideal health factor metrics compared with those with low or medium educational level (OR 0.88 95% CI 0.77 to 0.99 and OR 0.88 95% CI 0.80 to 0.96; OR 0.81 95% CI 0.69 to 0.96 and OR 0.77 95% CI 0.68 to 0.87; respectively). The number of ideal behaviour metrics was not a discriminator of educational groups. Concerning the categories of CVH status the poor CVH was a discriminator for low and medium education compared with those with high education (OR 1.93 95% CI 1.24 to 3.01 and OR 1.54 95% CI 1.08 to 2.19, respectively). CONCLUSIONS Our findings emphasise the large potential for preventing cardiovascular disease, showing a low proportion with a favourable CVH profile, especially among low-educated people. It is necessary to consider prevention strategies aimed at improving CVH in RS, targeting primarily low educational groups.
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Affiliation(s)
- Slavenka Janković
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | | | - Janko Janković
- Faculty of Medicine, Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
| | - Miloš Erić
- Faculty of Economics, Finance and Administration, Singidunum University, Belgrade, Serbia
| | - Jelena Marinković
- Faculty of Medicine, Institute of Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
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