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Hunjan I, Umulisa A, Parati G, Bianchetti MG, Milani GP, Muvunyi B, Ntaganda E, Radovanovic D, Stroppa C, Suter P, Muggli F. Blood pressure screening in Mata Sector, a rural area of Rwanda. J Hum Hypertens 2024:10.1038/s41371-024-00912-7. [PMID: 38658710 DOI: 10.1038/s41371-024-00912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
In rural sub-Saharan Africa, knowledge of non-communicable diseases such as high blood pressure (BP) is rather limited. This report provides information about a BP screening in Mata Sector, a rural region in Southern Province of Rwanda. Community-based, house-to-house screening was performed between February and July 2020 on more than 7000 inhabitants. The screening was conducted by a local team composed by 20 community health care workers, five community health care supervisors, and one nurse with hypertension surveillance training. BP and heart rate were recorded after 5 min of resting, using a validated automated oscillometric OMRON M6 IT-HEM-7322-E monitor with Intelli Wrap Cuff (HEM-FL31-E) technology. The mean of the second and third value was retained. BP was normal (<140/90 mm Hg) in 6340 (88%) and elevated in 863 (12%) participants with 95% of unawareness. Grade 1 (140-159/90-99 mm Hg) hypertensive BP readings were detected in 697 (81%), grade 2 (160-179/100-109 mm Hg) in 134 (16%), and grade 3 (≥180/≥110 mm Hg) in 32 (3.7%) individuals. The prevalence of hypertensive readings was significantly age-dependent. Additionally, a slightly greater proportion of participants with high BP (14% versus 11%) had a body mass index (BMI) ≥ 25.0 kg/m2. Also resting heart rate was higher in individuals with high BP (82 versus 77 beats/min). Although individuals identified with occasionally elevated BP values need further confirmatory measurements to establish the diagnosis of hypertension, these data suggest that high BP represents a noteworthy and preventable reason of concern within sub-Saharan Africa.
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Affiliation(s)
- Isabella Hunjan
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alice Umulisa
- Health Care Centre of Nyamyumba, District of Nyaruguru, Nyamyumba, Rwanda
| | - Gianfranco Parati
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, San Luca Hospital, Milan, Italy.
| | - Mario G Bianchetti
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Bienvenu Muvunyi
- Medical Specialized Services, King Faisal Hospital, Kigali, Rwanda
| | - Evariste Ntaganda
- Cardiovascular diseases Unit, Non-communicable diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Dragana Radovanovic
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Clara Stroppa
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Paolo Suter
- Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Franco Muggli
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Katsukunya JN, Soko ND, Naidoo J, Rayner B, Blom D, Sinxadi P, Chimusa ER, Dandara M, Dzobo K, Jones E, Dandara C. Pharmacogenomics of Hypertension in Africa: Paving the Way for a Pharmacogenetic-Based Approach for the Treatment of Hypertension in Africans. Int J Hypertens 2023; 2023:9919677. [PMID: 38633331 PMCID: PMC11022520 DOI: 10.1155/2023/9919677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 04/19/2024] Open
Abstract
In Africa, the burden of hypertension has been rising at an alarming rate for the last two decades and is a major cause for cardiovascular disease (CVD) mortality and morbidity. Hypertension is characterised by elevated blood pressure (BP) ≥ 140/90 mmHg. Current hypertension guidelines recommend the use of antihypertensives belonging to the following classes: calcium channel blockers (CCB), angiotensin converting inhibitors (ACEI), angiotensin receptor blockers (ARB), diuretics, β-blockers, and mineralocorticoid receptor antagonists (MRAs), to manage hypertension. Still, a considerable number of hypertensives in Africa have their BP uncontrolled due to poor drug response and remain at the risk of CVD events. Genetic factors are a major contributing factor, accounting for 20% to 80% of individual variability in therapy and poor response. Poor response to antihypertensive drug therapy is characterised by elevated BPs and occurrence of adverse drug reactions (ADRs). As a result, there have been numerous studies which have examined the role of genetic variation and its influence on antihypertensive drug response. These studies are predominantly carried out in non-African populations, including Europeans and Asians, with few or no Africans participating. It is important to note that the greatest genetic diversity is observed in African populations as well as the highest prevalence of hypertension. As a result, this warrants a need to focus on how genetic variation affects response to therapeutic interventions used to manage hypertension in African populations. In this paper, we discuss the implications of genetic diversity in CYP11B2, GRK4, NEDD4L, NPPA, SCNN1B, UMOD, CYP411, WNK, CYP3A4/5, ACE, ADBR1/2, GNB3, NOS3, B2, BEST3, SLC25A31, LRRC15 genes, and chromosome 12q loci on hypertension susceptibility and response to antihypertensive therapy. We show that African populations are poorly explored genetically, and for the few characterised genes, they exhibit qualitative and quantitative differences in the profile of pharmacogene variants when compared to other ethnic groups. We conclude by proposing prioritization of pharmacogenetics research in Africa and possible adoption of pharmacogenetic-guided therapies for hypertension in African patients. Finally, we outline the implications, challenges, and opportunities these studies present for populations of non-European descent.
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Affiliation(s)
- Jonathan N. Katsukunya
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Nyarai D. Soko
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Jashira Naidoo
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Brian Rayner
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dirk Blom
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Lipidology and Cape Heart Institute, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Phumla Sinxadi
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Clinical Pharmacology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile R. Chimusa
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle, Tyne and Wear NE1 8ST, UK
| | - Michelle Dandara
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
| | - Kevin Dzobo
- Medical Research Council-SA Wound Healing Unit, Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences University of Cape Town, Anzio Road Observatory, Cape Town 7925, South Africa
| | - Erika Jones
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
- Department of Medicine, Division of Nephrology and Hypertension, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCT/South African Medical Research Council (SAMRC) Platform for Pharmacogenomics Research and Translation Unit, University of Cape Town, Cape Town, South Africa
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Halla FF, Massawa SM, Joseph EK, Acharya K, Sabai SM, Mgana SM, Werner D. Attenuation of bacterial hazard indicators in the subsurface of an informal settlement and their application in quantitative microbial risk assessment. Environ Int 2022; 167:107429. [PMID: 35914337 DOI: 10.1016/j.envint.2022.107429] [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] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
Pit latrines provide essential onsite sanitation services to over a billion people, but there are concerns about their role in infectious disease transmission, and impacts on groundwater resources. We conducted fieldwork in an informal settlement in Dar es Salaam, where cholera is endemic. We combined plate counting with portable MinION sequencing and quantitative polymerase chain reaction (qPCR) methods for characterization of bacteria in pit latrine sludge, leachate, shallow and deep groundwater resources. Pit latrine sludge was characterized by log10 marker gene concentrations per 100 mL of 11.2 ± 0.2, 9.9 ± 0.9, 6.0 ± 0.3, and 4.4 ± 0.8, for total bacteria (16S rRNA), E. coli (rodA), human-host-associated Bacteroides (HF183), and Vibrio cholerae (ompW), respectively. The ompW gene observations suggested 5 % asymptomatic Vibrio cholerae carriers amongst pit latrine users. Pit leachate percolation through one-meter-thick sand beds attenuated bacterial hazard indicators by 1 to 4 log10 units. But first-order removal rates derived from these data substantially overestimated the longer-range hazard attenuation in the sand aquifers. Cooccurrence of human sewage marker gene HF183 in all shallow groundwater samples testing positive for ompW genes demonstrated the human origin of Vibrio cholerae hazards in the subsurface. All borehole water samples tested negative for ompW and HF183 genes, but 16S rRNA gene sequencing data suggested ingress of faecal pollution into boreholes at the peak of the "long rainy season". Quantitative microbial risk assessment (QMRA) predicted a gastrointestinal disease burden of 0.05 DALY per person per year for the community, well above WHO targets of 10-4-10-6 DALY for disease related to drinking water.
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Affiliation(s)
- Franella Francos Halla
- Department of Environmental Engineering, School of Environmental Science and Technology, Ardhi University, Dar es Salaam, Tanzania
| | - Said Maneno Massawa
- Department of Environmental Engineering, School of Environmental Science and Technology, Ardhi University, Dar es Salaam, Tanzania
| | - Elihaika Kengalo Joseph
- Department of Environmental Engineering, School of Environmental Science and Technology, Ardhi University, Dar es Salaam, Tanzania
| | - Kishor Acharya
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Shadrack Mwita Sabai
- Department of Environmental Engineering, School of Environmental Science and Technology, Ardhi University, Dar es Salaam, Tanzania
| | - Shaaban Mrisho Mgana
- Department of Environmental Engineering, School of Environmental Science and Technology, Ardhi University, Dar es Salaam, Tanzania.
| | - David Werner
- School of Engineering, Newcastle University, Newcastle upon Tyne NE1 7RU, UK.
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Pallangyo P, Komba M, Mkojera ZS, Mayala HA, Bhalia SV, Millinga J, Wibonela S, Swai G, Minja DA, Janabi M. Non-Communicable Disease Risk Factors Among Caregivers of Patients Attending a Tertiary Cardiovascular Hospital in Tanzania. Int J Gen Med 2022; 15:4685-4696. [PMID: 35548586 PMCID: PMC9084384 DOI: 10.2147/ijgm.s364392] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/20/2022] [Indexed: 01/01/2023] Open
Abstract
Background Notwithstanding the ever-present burden of infectious diseases, the sub-Saharan Africa (SSA) region has experienced a 67% rise in the non-communicable disease (NCD) burden in less than three decades. Furthermore, regardless of the increased recognition of NCDs threat in the region, reliable local estimates and associated drivers are generally lacking. We therefore conducted this cross-sectional study to establish the pattern and correlates of the modifiable NCD risk factors among caregivers of patients attending a tertiary cardiovascular centre in Tanzania. Methods A cross-sectional survey was conducted at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania. We used a structured questionnaire bearing a modified WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) tool to explore the modifiable behavioral and modifiable biological NCD risk factors. Results A total of 1063 caregivers were enrolled in this study. The mean age was 40.5 years, and 55.7% were female. Nearly 80% of participants had a good knowledge regarding NCDs and 85.4% had a positive family history of NCDs. Overall, 1027 (96.6%) participants had at least one modifiable NCD risk factor while 510 (48.0%) had three or more (i.e., clustering). With respect to modifiable behavioral NCD risk factors, 34 (3.2%) were tobacco users, 56 (5.3%) had harmful alcohol consumption, 691 (65%) had unhealthy eating behavior, and 820 (77.1%) were physically inactive. Pertaining to modifiable biological NCD risk factors, 710 (66.8%) had excess body weight, 420 (39.5%) had hypertension and 62 (5.8%) were diabetic. Conclusion A vast majority of caregivers of NCD patients in this tertiary setting were found to have modifiable NCD risk factors with a strong tendency of clustering. These findings call for intensification of both population strategies and targeted group interventions for better control of the NCD threat and its correlates.
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Affiliation(s)
- Pedro Pallangyo
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
- Correspondence: Pedro Pallangyo, Email
| | - Makrina Komba
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Zabella S Mkojera
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Henry A Mayala
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Smita V Bhalia
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Department of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Gudila Swai
- Department of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Dickson A Minja
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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Miyashita A, Nakamura K, Ohnishi M, Bintabara D, Shayo FK, Maro II, Sato H, Seino K, Kibusi S. Reaching Patients With Noncommunicable Diseases in Rural Tanzania Using Mobile Devices and Community Trust: Qualitative Study. JMIR Mhealth Uhealth 2022; 10:e29407. [PMID: 35297772 PMCID: PMC8972119 DOI: 10.2196/29407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/25/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background A health service using mobile devices, mobile health (mHealth), has been widely applied to programs focusing on maternal and child health and communicable diseases in sub-Saharan African countries. However, mHealth apps for noncommunicable disease (NCD) services remain limited. Objective This study aimed to explore the acceptability and potential usability of SMS text messaging for patients and health care providers for the management of NCDs as part of an implementation research in rural Tanzania. Methods Nine focus group discussions were conducted with 56 participants (21 community health workers [CHWs], 17 patients, and 18 health care professionals [HPs]) in 3 districts in the Dodoma region, Tanzania. The interview guides were prepared in Swahili, and each session was recorded, transcribed, and translated into English. The focus group discussions consisted of the following topics: (1) perceptions of the participants about the possible use of mobile devices and SMS text messages as an mHealth platform in community health services; and (2) experiences of mobile device use in health activities or receiving health services via a mobile phone in the past. Results CHWs and HPs reported having familiarity using mobile devices to provide health services, especially for reaching or tracing patients in remote settings; however, patients with NCDs were less familiar with the use of mobile devices compared with the other groups. Hesitation to receive health services via SMS text messaging was seen in the patient group, as they wondered who would send health advice to them. Some patients expected services beyond what mHealth could do, such as aiding in recovery from a disease or sending notifications about the availability of prescription medications. CHWs showed interest in using text messaging to provide health services in the community; however, the concerns raised by CHWs included the cost of using their own mobile devices. Moreover, they demanded training about NCD management before engaging in such an activity. Conclusions This study explored views and experiences regarding the possible installation of an mHealth intervention for managing NCDs in rural Tanzania. Although HPs and CHWs had experience using mobile devices to provide health services in non-NCD projects, only a few patients (3/17, 17%) had heard about the use of mobile devices to receive health services. To improve the suitability and acceptability of the intervention design for patients with NCDs, their trust must be earned. Involving CHWs in the intervention is recommended because they have already been appointed in the community and already know how to communicate effectively with patients in the area.
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Affiliation(s)
- Ayano Miyashita
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mayumi Ohnishi
- Department of Community-Based Rehabilitation Sciences, Nagasaki University, Nagasaki, Japan
| | - Deogratius Bintabara
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
- College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania
| | - Festo K Shayo
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Isaac I Maro
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
- The Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Hideko Sato
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo, Japan
| | - Stephen Kibusi
- College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania
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Khamis AG, Senkoro M, Mwanri AW, Kreppel K, Mfinanga SG, Bonfoh B, Kwesigabo G. Prevalence and determinants of hypertension among pastoralists in Monduli District, Arusha region in Tanzania: a cross-sectional study. ACTA ACUST UNITED AC 2020; 78:99. [PMID: 33072318 PMCID: PMC7556965 DOI: 10.1186/s13690-020-00485-0] [Citation(s) in RCA: 9] [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: 05/20/2020] [Accepted: 10/06/2020] [Indexed: 01/13/2023]
Abstract
Background Hypertension is among the growing non-communicable diseases (NCDs) in developing countries and the leading cause of death worldwide. Pastoral areas have been identified to be at a higher risk of diseases due to challenges in their daily food production, livelihoods or mobility. Unfortunately, the prevalence of hypertension and the risk factors particularly affecting rural and pastoral populations are not fully understood, making intervention efforts challenging. The aim of this study was to determine the prevalence of hypertension and identify the risk factors among adults living in Monduli district in Tanzania. The findings will be useful for the provision of tailored interventions focused on community-specific nutritional and behavioral practices. Methods We conducted a community based cross-sectional study involving a sample of 510 adults aged above 18 years selected using a multistage cluster sampling in the Monduli district of Arusha region, Tanzania. Data were collected by using interviewer-administered questionnaires containing socio-demographic, physical activity, smoking and alcohol consumption. Anthropometry, systolic (SBP) and diastolic blood pressure (DBP) levels were measured. A one-day 24 h diet recall was conducted to evaluate the dietary habits of all participants. Both linear and logistic regression analysis were used to identify the independent predictors for hypertension and blood pressure levels. Results The prevalence of hypertension in this study was 25.7% (n = 131, 95% CI; 22.1–29.7). The odds of hypertension increased with being male (AOR = 1.75, 95%CI, 1.06–2.88), belonging to the older age group of 30–39 year olds (AOR = 3.3, 95%CI, 1.76–6.38), 40–59 year olds (AOR = 3.34, 95%CI, 1.75–6.37) and ≥ 60 year olds (AOR = 4.2, 95%CI, 2.02–8.87), being overweight or obese (AOR = 3.37, 95%CI, 1.18–9.62), have more hours spent sedentary (AOR = 3.19, 95%CI, 1.61–6.32), and consumption of fatty foods (AOR = 2.23, 95%CI, 1.27–3.93). The odds for hypertension was significantly reduced among participants who reported higher income (AOR = 0.47, 95% CI, 0.25–0.91), high level of physical activity (AOR = 0.55, 95%CI, 0.31–0.96) and those reported to consume fruit (AOR = 0.37, 95% CI, 0.18–0.77). Consumption of cereals was negatively associated with levels of SBP (β = − 17.4, 95% CI, − 23.8; − 11.0) and DBP (β = − 6.6, 95% CI, − 11.5,-1.79). Conclusion About one in every four adults living in pastoral communities have been found to have hypertension in this study. Our findings suggest that older age, obesity or overweight, low physical activity, low income, and consumption of fatty foods increase the risk of hypertension among study population. Their diet was dominated by cereals with moderate intake of meat and milk and low fruits. There is a need to promote physical activities and consumption of fruits in the study population in order to fight against hypertension. Further research should be done to confirm the associations.
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Affiliation(s)
- Ahmed Gharib Khamis
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Mbazi Senkoro
- National Institute for Medical Research, Muhimbili Research Centre, Dar-es-Salaam, Tanzania
| | - Akwilina Wendelin Mwanri
- Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Chuo Kikuu Tanzania
| | - Katharina Kreppel
- School of Life Sciences and Bio-Engineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.,Department of Environmental Health and Ecological Sciences, Ifakara Health Institute, Dar-es-salaam, Tanzania
| | | | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Gideon Kwesigabo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
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Pallangyo P, Mkojera ZS, Hemed NR, Swai HJ, Misidai N, Mgopa L, Bhalia S, Millinga J, Mushi TL, Kabeya L, Omar A, Kaijage A, Mulashani R, Mosha S, Mwapinga F, Janabi M. Obesity epidemic in urban Tanzania: a public health calamity in an already overwhelmed and fragmented health system. BMC Endocr Disord 2020; 20:147. [PMID: 32993615 PMCID: PMC7526153 DOI: 10.1186/s12902-020-00631-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 03/10/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Worldwide, the epidemiological and demographic transitions have resulted in nutrition shift characterized by an increased consumption of high energy fast food products. In just over 3 decades, overweight and obesity rates have nearly tripled to currently affecting over a third of the global population. Notwithstanding the ever present under-nutrition burden, sub Saharan Africa (SSA) is witnessing a drastic escalation of overweight and obesity. We aimed to explore the prevalence and associated factors for obesity among residents of Dar es Salaam city in Tanzania. METHODS Participants from this study were recruited in a community screening conducted during the Dar es Salaam International Trade Fair. Sociodemographic and clinical data were gathered using a structured questionnaire during enrollment. Dietary habits and anthropometric measurements were assessed using standard methods. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student's T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with BMI ≥ 25. All tests were 2-sided and p < 0.05 was used to denote a statistical significance. RESULTS A total of 6691 participants were enrolled. The mean age was 43.1 years and males constituted 54.2% of all participants. Over two-thirds of participants were alcohol consumers and 6.9% had a positive smoking history. 88.3% of participants were physically inactive, 4.7% had a history of diabetes mellitus and 18.1% were known to have elevated blood pressure. Overweight and obesity were observed in 34.8 and 32.4% of participants respectively. Among overweight and obese participants, 32.8% had a misperception of having a healthy weight. Age ≥ 40, female gender, a current working status, habitual breakfast skipping, poor water intake, high soft drink consumption, regular fast food intake, low vegetable and fruit consumption, alcohol consumption and hypertension were found to be independent associated factors for obesity. CONCLUSION Amidst the ever present undernutrition in SSA, a significant proportion of participants had excess body weight. Concomitantly, the rates of physical inactivity and unhealthy eating are disproportionately high in Dar es Salaam. In view of this, community-based and multilevel public health strategies to promote and maintain healthy eating and physical activity require an urgent step-up in urban Tanzania.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
- Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Zabella S. Mkojera
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Naairah R. Hemed
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Happiness J. Swai
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Lucy Mgopa
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Theophil L. Mushi
- Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Lucia Kabeya
- Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Aisha Omar
- Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Alice Kaijage
- Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Rydiness Mulashani
- Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Silvia Mosha
- Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Faustina Mwapinga
- Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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8
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Hoffman DJ. Use of Beetroot Juice Extract for Hypertension Treatment in Low- and Middle-Income Countries. J Nutr 2020; 150:2233-2234. [PMID: 32725193 DOI: 10.1093/jn/nxaa215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/18/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Daniel J Hoffman
- Department of Nutritional Sciences, Program in International Nutrition; Center for Childhood Nutrition Research, New Jersey Institute for Food, Nutrition, and Health; Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Kuate Defo B, Mbanya JC, Kingue S, Tardif JC, Choukem SP, Perreault S, Fournier P, Ekundayo O, Potvin L, D'Antono B, Emami E, Cote R, Aubin MJ, Bouchard M, Khairy P, Rey E, Richard L, Zarowsky C, Mampuya WM, Mbanya D, Sauvé S, Ndom P, Silva RBD, Assah F, Roy I, Dubois CA. Blood pressure and burden of hypertension in Cameroon, a microcosm of Africa: a systematic review and meta-analysis of population-based studies. J Hypertens 2019; 37:2190-9. [PMID: 31166251 DOI: 10.1097/HJH.0000000000002165] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text To estimate national and geography-based variations in blood pressure and burden of hypertension in Cameroon, generally called ‘miniature Africa’.
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10
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Kandhari N, Prabhakar M, Shannon O, Fostier W, Koehl C, Rogathi J, Temu G, Stephan BCM, Gray WK, Haule I, Paddick SM, Mmbaga BT, Walker R, Siervo M. Feasibility and acceptability of a nutritional intervention testing the effects of nitrate-rich beetroot juice and folic acid on blood pressure in Tanzanian adults with elevated blood pressure. Int J Food Sci Nutr 2020; 72:195-207. [PMID: 32522060 DOI: 10.1080/09637486.2020.1776226] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sub-Saharan African countries are experiencing an alarming increase in hypertension prevalence. This study evaluated the feasibility and acceptability of nitrate-rich beetroot and folate supplementation, alone or combined, for the reduction of blood pressure (BP) in Tanzanian adults with elevated BP. This was a three-arm double-blind, placebo-controlled, parallel randomised clinical trial. Forty-eight participants were randomised to one of three groups to follow a specific 60-day intervention which included a: (1) combined intervention (beetroot juice + folate), (2) single intervention (beetroot juice + placebo), and (3) control group (nitrate-depleted beetroot juice + placebo). Forty-seven participants (age: 50-70 years) completed the study. The acceptability of the interventions was high. Self-reported compliance to the interventions was more than 90% which was confirmed by the significant increase in nitrate and folate concentrations in plasma and saliva samples in the treatment arms. This study provides important information for the design of high-nitrate interventions to reduce BP in Sub-Saharan African countries.
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Affiliation(s)
- Navneet Kandhari
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Meghna Prabhakar
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Oliver Shannon
- Human Nutrition Research Centre, Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - William Fostier
- Human Nutrition Research Centre, Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christina Koehl
- Human Nutrition Research Centre, Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Rogathi
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Tanzania, UK
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Tanzania, UK
| | - Blossom C M Stephan
- Institute of Mental Health, The University of Nottingham Medical School, Nottingham, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Irene Haule
- District Medical Officer, Hai District Hospital, Bomangombe, Tanzania
| | - Stella-Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK.,Clinical and Translational Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Tanzania, UK.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK.,Population of Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mario Siervo
- School of Life Sciences, Queen's Medical Centre, The University of Nottingham Medical School, Nottingham, UK
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11
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Diarz EJ, Leyaro BJ, Kivuyo SL, Ngowi BJ, Msuya SE, Mfinanga SG, Bonfoh B, Mahande MJ. Red meat consumption and its association with hypertension and hyperlipidaemia among adult Maasai pastoralists of Ngorongoro Conservation Area, Tanzania. PLoS One 2020; 15:e0233777. [PMID: 32479535 PMCID: PMC7263614 DOI: 10.1371/journal.pone.0233777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/16/2019] [Accepted: 05/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Red meat is an important dietary source of protein and other essential nutrients. Its high intake has been associated with an increased risk of cardiovascular morbidity and mortality, including hypertension (HTN) and hyperlipidaemia (HLP). Despite being physically active, the Maasai at Ngorongoro Conservation Area (NCA) depend heavily on animals' products as their staple food with fewer intakes of vegetables or fruits due to restriction from carrying out agricultural activities within the NCA. This study aimed at determining the prevalence of HTN and HLP and their association with red meat consumption among adult Maasai of NCA. METHODS A community-based cross-sectional study was conducted in October 2018 using multistage sampling technique. Eight hundred and ninety-four (894) participants enrolled from seven villages in three wards within NCA Data were collected using a modified WHO NCDs-STEPS tool. Anthropometric measurements, blood pressure (BP) measurements, and blood samples for glucose and cholesterol tests were obtained from the study participants. Crude and adjusted prevalence ratio (PR) for factors associated with HTN and HLP were estimated using Ordinal and Bayesian logistic regression models, respectively. RESULTS The prevalence of HLP was 23.7 percent. The levels were higher among males than were among the females (29.0% vs. 20.1%, p = 0.002). The prevalence of HTN and pre-HTN (elevated BP) were 9.8 and 37.0 percent, respectively. Both HTN and elevated BP were higher among males than were among females (hypertensive [10.9% vs. 9.0%]; elevated BP [44.0% vs. 32.1%], p<0.001). The prevalence of HLP was significantly associated with level II (PR = 1.56, 95%CrI: 1.10-2.09) and level III (PR = 1.64, 95%CrI: 1.08-2.41) of red meat consumption as opposed to level I. CONCLUSION The prevalence of hyperlipidaemia and elevated BP were high among NCA Maasai. We found a significant association between red meat consumption and hyperlipidaemia. Further follow-up studies are warranted to establish a temporal relationship between red meat consumption and both conditions.
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Affiliation(s)
- Ester J. Diarz
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es salaam, Tanzania
- * E-mail:
| | - Beatrice J. Leyaro
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Sokoine L. Kivuyo
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es salaam, Tanzania
| | - Bernard J. Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es salaam, Tanzania
- Mbeya College of Health and Allied Sciences, University of Dar es salaam, Mbeya, Tanzania
| | - Sia E. Msuya
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Department of Community Medicine, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Sayoki G. Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es salaam, Tanzania
- The Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Michael J. Mahande
- Department of Epidemiology and Applied Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
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12
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Sarfo FS, Mobula L, Plange‐Rhule J, Gebregziabher M, Ansong D, Sarfo‐Kantanka O, Arthur L, Sablah J, Gavor E, Burnham G, Ofori‐Adjei D. Longitudinal control of blood pressure among a cohort of Ghanaians with hypertension: A multicenter, hospital‐based study. J Clin Hypertens (Greenwich) 2020; 22:949-958. [DOI: 10.1111/jch.13873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/12/2020] [Accepted: 03/04/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Fred S. Sarfo
- Department of Medicine Kwame Nkrumah University of Science & Technology Kumasi Ghana
- Department of Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | - Linda Mobula
- Johns Hopkins University School of Medicine Baltimore MD USA
- Johns Hopkins University Bloomberg School of Public Health Baltimore MD USA
| | | | | | - Daniel Ansong
- Department of Medicine Kwame Nkrumah University of Science & Technology Kumasi Ghana
- Department of Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | | | - Lynda Arthur
- Ghana Access and Affordability Program Accra Ghana
| | | | - Edith Gavor
- Ghana National Drugs Programme Ministry of Health Accra Ghana
| | - Gilbert Burnham
- Johns Hopkins University School of Medicine Baltimore MD USA
- Johns Hopkins University Bloomberg School of Public Health Baltimore MD USA
| | - David Ofori‐Adjei
- Department of Medicine & Therapeutics University of Ghana School of Medicine and Dentistry Accra Ghana
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13
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Akwanalo C, Njuguna B, Mercer T, Pastakia SD, Mwangi A, Dick J, Dickhaus J, Andesia J, Bloomfield GS, Valente T, Kibachio J, Pillsbury M, Pathak S, Thakkar A, Vedanthan R, Kamano J, Naanyu V. Strategies for Effective Stakeholder Engagement in Strengthening Referral Networks for Management of Hypertension Across Health Systems in Kenya. Glob Heart 2020; 14:173-179. [PMID: 31324372 DOI: 10.1016/j.gheart.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Ineffective referral networks in low- and middle-income countries hinders access to evidence-based therapies by hypertensive patients, leading to high cardiovascular mortality and morbidity. The STRENGTHS (Strengthening Referral Networks for Management of Hypertension Across Health Systems) study evaluates strategies to improve referral processes utilizing the International Association of Public Participation framework to engage stakeholders. OBJECTIVES This study sought to identify and engage key stakeholders involved in referral of patients in the Ministry of Health, western Kenya. METHODS Key stakeholders involved in policy formulation, provision, or consumption of public health care service were mapped out and contacted by phone, letters, and emissaries to schedule meetings, explain research objectives, and obtain feedback. RESULTS Key stakeholders identified were the Ministry of Health, the Academic Model Providing Access to Healthcare, health professionals, communities and their leadership, and patients. Engaging them resulted in permission to contact research in their areas of jurisdiction and enabled collaboration in updating care protocols with emphasis on timely and appropriate referrals. CONCLUSIONS Early stakeholder identification and engagement using the International Association of Public Participation model eased explanation of research objectives, building consensus, and shaping the interventions to improve the referral process.
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Affiliation(s)
- Constantine Akwanalo
- College of Health Sciences, Moi University, Eldoret, Kenya; Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | | | - Tim Mercer
- Department of Population Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Sonak D Pastakia
- College of Health Sciences, Moi University, Eldoret, Kenya; College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Ann Mwangi
- College of Health Sciences, Moi University, Eldoret, Kenya
| | | | - Julia Dickhaus
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | | | | | | | - Joseph Kibachio
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Max Pillsbury
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Jemima Kamano
- College of Health Sciences, Moi University, Eldoret, Kenya; Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Violet Naanyu
- College of Health Sciences, Moi University, Eldoret, Kenya
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14
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Brackmann LK, Buck C, Nyangasa MA, Kelm S, Sheikh M, Hebestreit A. Anthropometric and Biochemical Predictors for Hypertension in a Cross-Sectional Study in Zanzibar, Tanzania. Front Public Health 2019; 7:338. [PMID: 31824908 PMCID: PMC6881248 DOI: 10.3389/fpubh.2019.00338] [Citation(s) in RCA: 3] [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] [Received: 11/20/2018] [Accepted: 10/29/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Aim of this study was to describe the proportion of hypertension among Zanzibari of different age-groups and to detect possible correlates of this non-communicable disease. Methods: In 2013 a cross-sectional survey was conducted in Unguja Island, Zanzibar. A total of 235 randomly selected households, including 1,229 (2 to 95 years) eligible study participants, were examined. Association between objectively assessed obesity markers, salt intake and hypertension were investigated. Estimates of 24 h sodium and potassium excretion from a single morning spot urine specimen were calculated and used as surrogate for salt intake. The association between overweight/obesity and hypertension in different age-groups was assessed in multilevel logistic regression models. Further associations between salt intake and hypertension were analyzed. Results: Measures of systolic and diastolic blood pressure as well as proportion of overweight/obesity and hypertension both increased with age. Overweight and obesity were significantly associated with hypertension in adults. Moreover, thinness seems to be associated with hypertension as well. We observed a significantly reduced chance of hypertension for higher urinary sodium-to-potassium compared to a lower ratio in children. Conclusion: Overweight/obesity and hypertension were highly prevalent (>47% of adults >40 years are overweight or obese and >69% are hypertensive in the same age group) in our sample. Weight status was confirmed as a correlate of high blood pressure in our sample from Zanzibar, Tanzania. To early and effectively prevent related severe cardiovascular outcomes, screening strategies but also monitoring strategies are required for this population.
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Affiliation(s)
- Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Christoph Buck
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Biometry and Data Mangement, Bremen, Germany
| | - Maria Adam Nyangasa
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Epidemiological Methods and Etiological Research, Bremen, Germany
| | - Soerge Kelm
- Center for Biomolecular Interactions Bremen, Faculty for Biology and Chemistry, University Bremen, Bremen, Germany
| | - Mohammed Sheikh
- Environmental Analytical Chemistry and Eco-toxicology Lab, State University of Zanzibar, Zanzibar, Tanzania
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Department of Epidemiological Methods and Etiological Research, Bremen, Germany
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15
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Mamo Y, Bekele F, Nigussie T, Zewudie A. Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study. BMC Endocr Disord 2019; 19:91. [PMID: 31464602 PMCID: PMC6716911 DOI: 10.1186/s12902-019-0421-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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] [Received: 11/19/2018] [Accepted: 08/20/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE AND BACKGROUND In 2015 approximately 5.0 million people were estimated to have died from diabetes. Poor glycemic control is the most determinant of diabetes-related complication and death. The percentage of patients whose blood glucose level are not well controlled remains high yet. The aim of this study is to identify the determinants of poor glycemic control at the diabetes clinic of the Jimma University Medical Center from April 01 to June 30/2017. METHODS Facility-based case-control study design was conducted on patients with type 2 diabetes mellitus on follow-up at the diabetes clinic of Jimma University medical center. The consecutive sampling technique was employed and data were collected from April to June 2017. The data were entered using Epidata manager version 4.0.2 and exported to SPSS Version 21 for analysis. Logistic regression analysis was performed and variables with the p-value of less than 0.05 were considered as statistically significant determinants of poor glycemic control. RESULT The study was conducted on 410 patients, of which 228 males and 182 females. The determinants of poor glycemic control were comorbidities [Adjusted odd ratio(AOR) = 2.56, 95%CI = 1.10-5.96], lack of self-monitoring blood glucose [AOR = 3.44,95%CI = 1.33-8.94], total cholesterol level of 200 mg/dl or more [AOR = 3.62, 95%CI = 1.46-8.97], diabetes duration of greater than 7 years [AOR = 3.08, 95%CI = 1.33-7.16], physical activity of three or less than three days [AOR = 4.79, 95%CI = 1.70-13.53], waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female [AOR = 3.52, 95%CI = 1.23-10.11], being on metformin plus insulin [AOR = 9.22, 95%CI = 2.90-29.35] and being on insulin [AOR = 4.48, 95%CI = 1.52-13.16]. CONCLUSION Lack of Self-monitoring blood glucose, presence of comorbidities, duration of diabetes mellitus, physical activity of three or less than three days, total cholesterol of 200 mg/dl or more, waist to hip ratio of 0.9 or greater for male and 0.85 or greater for female, and types of antidiabetic medication were the independent predictors of poor glycemic control. Effort should be made towards reducing these factors by the concerned body.
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Affiliation(s)
- Yitagesu Mamo
- Department of Pharmacy, College of medicine and health science, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Fekede Bekele
- Department of Pharmacy, Jimma University Institute of Health Science, Jimma, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health, College of medicine and health science, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Ameha Zewudie
- Department of Pharmacy, College of medicine and health science, Mizan Tepi University, Mizan Teferi, Ethiopia
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16
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Noubiap JJ, Nansseu JR, Endomba FT, Ngouo A, Nkeck JR, Nyaga UF, Kaze AD, Bigna JJ. Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis. Sci Rep 2019; 9:588. [PMID: 30679752 PMCID: PMC6345945 DOI: 10.1038/s41598-018-37858-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 07/16/2018] [Accepted: 12/15/2018] [Indexed: 12/27/2022] Open
Abstract
The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6–15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6–16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.
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Affiliation(s)
- Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Francky Teddy Endomba
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Anderson Ngouo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jan René Nkeck
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Arnaud D Kaze
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon. .,Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France.
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Abstract
Non-communicable diseases (NCDs) are the leading cause of death globally, the majority of these being due to cardiovascular disease, cancer, chronic respiratory diseases, or diabetes. Mortality from many NCDs continues to increase worldwide, with a disproportionately larger impact in low-middle income countries (LMIs), where almost 75% of global deaths occur from these causes. As a low-income African country that consistently ranks amongst the world's poorest nations, Malawi as a case study demonstrates how transition due to societal change and increasing urbanization is often accompanied by a rise in the rate of NCDs. Other factors apart from changing lifestyle factors can explain at least some of this increase, such as the complex relationship between communicable and NCD and growing environmental, occupational, and cultural pressures. Malawi and other LMIs are struggling to manage the increasing challenge of NCDs, in addition to an already high communicable disease burden. However, health care policy implementation, specific health promotion campaigns, and further epidemiological research may be key to attenuating this impending health crisis, both in Malawi and elsewhere. This review aims to examine the effects of the major NCDs in Malawi to help inform future public health care policy in the region.
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Affiliation(s)
- Matthew Gowshall
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, London, UK, ,
- Barts and the London School of Medicine and Dentistry, London, UK,
| | - Simon D Taylor-Robinson
- Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, London, UK, ,
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18
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Sarfo FS, Mobula LM, Burnham G, Ansong D, Plange-Rhule J, Sarfo-Kantanka O, Ofori-Adjei D. Factors associated with uncontrolled blood pressure among Ghanaians: Evidence from a multicenter hospital-based study. PLoS One 2018; 13:e0193494. [PMID: 29554106 PMCID: PMC5858765 DOI: 10.1371/journal.pone.0193494] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 07/29/2017] [Accepted: 02/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of uncontrolled hypertension in Low-and-Middle Income Countries (LMICs) is high, with an increased risk of cardiovascular diseases and chronic renal failure in these settings. OBJECTIVE To assess the factors associated with uncontrolled blood pressure control in a cross-section of Ghanaian hypertensive subjects involved in an on-going multicenter epidemiological study aimed at improving access to hypertension treatment. METHODS A cross-sectional study involving 2,870 participants with hypertension with or without diabetes who were enrolled at 5 hospitals in Ghana (2 tertiary, 2 district and 1 rural hospital). Data on demographics, medical history, lifestyle factors, anti-hypertensive medications and treatment adherence were collected. The 14-item version of the Hill-Bone compliance to high blood pressure therapy scale was used to assess adherence to treatment in 3 domains namely adherence to medications, salt intake and clinic appointments. Questionnaires on knowledge, attitudes and practices on hypertension, sources of antihypertensive medications and challenges with accessing these medications were also administered. Blood pressure, weight and height were measured for each subject at enrollment. Factors associated with uncontrolled blood pressure (>140/90mmHg) were assessed using a multivariate logistic regression model. RESULTS The mean ± SD age of study participants was 58.9 ± 16.6 years, with a female preponderance (76.8%). Among study participants, 1,213 (42.3%) study participants had blood pressure measurements under control. Factors that remained significantly associated with uncontrolled blood pressure with adjusted OR (95% CI) included receiving therapy at a tertiary level of care: 2.47 (1.57-3.87), longer duration of hypertension diagnosis: 1.01 (1.00-1.03), poor adherence to therapy: 1.21 (1.09-1.35) for each 5 points higher score on the Hill-Bone scale, reported difficulties in obtaining antihypertensive medications: 1.24 (1.02-1.49) and number of antihypertensive medications prescribed: 1.32 (1.21-1.44). CONCLUSION We have found high rates of uncontrolled blood pressure among Ghanaian patients with hypertension accessing healthcare in public institutions. The system-level and individual-level factors associated with poor blood pressure control should be addressed to improve hypertension management among Ghanaians.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | - Linda M. Mobula
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gilbert Burnham
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Daniel Ansong
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Osei Sarfo-Kantanka
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Ofori-Adjei
- Department of Medicine & Therapeutics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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Zack RM, Irema K, Kazonda P, Leyna GH, Liu E, Spiegelman D, Fawzi W, Njelekela M, Killewo J, Danaei G. Determinants of high blood pressure and barriers to diagnosis and treatment in Dar es Salaam, Tanzania. J Hypertens 2016; 34:2353-64. [PMID: 27648720 DOI: 10.1097/HJH.0000000000001117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We assessed the prevalence and determinants of high blood pressure (BP), and barriers to diagnosis and treatment, in Dar es Salaam, Tanzania. METHODS We surveyed and screened 2174 community-dwelling adults aged at least 40 years in 2014 and conducted a follow-up after 1 year. RESULTS Median BP was 131/81 mmHg, and hypertension prevalence was 37%. Mean adjusted difference in SBP was 4.0 mmHg for overweight, 6.3 mmHg for obese class I, and 10.5 mmHg for obese class II/III compared with normal weight participants. Those who were physically inactive had 4.8 mmHg higher SBP compared with those with more than 24 h of moderate or vigorous activity per week. Drinkers of at least 10 g of alcohol per day had 4.5 mmHg higher SBP than did nondrinkers. Among hypertensive participants, 48% were previously diagnosed, 22% were treated, and 10% were controlled. Hypertensive participants without health insurance were 12% less likely to have been previously diagnosed than insured hypertensive participants. Of referred participants, 68% sought care, but only 27% were on treatment and 8% had controlled BP at follow-up. Reasons for not seeking care included lack of symptoms, cost of visit, and lack of time. Reasons for not being on treatment included lack of symptoms, not being prescribed treatment, and having finished one course of treatment. CONCLUSION Major risk factors for hypertension in Dar es Salaam are overweight, obesity, inadequate physical activity, and limited access to quality medical care. Increased insurance coverage and community-based screening, along with quality medical care and patient education, may help control this burgeoning epidemic.
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Anderson AK. Prevalence of Anemia, Overweight/Obesity, and Undiagnosed Hypertension and Diabetes among Residents of Selected Communities in Ghana. Int J Chronic Dis 2017; 2017:7836019. [PMID: 28894787 DOI: 10.1155/2017/7836019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/12/2017] [Indexed: 11/23/2022] Open
Abstract
The increasing numbers of lifestyle related chronic diseases in developing countries call for awareness, early detection, and effective management. The objective of this paper is to report the prevalence of undiagnosed hypertension, diabetes, overweight/obesity, and anemia among residents of selected communities in Ghana. The data comes from a community screening conducted in Ghana as part of the University of Georgia Summer Service Learning Program. Descriptive statistics were used to summarize the data while chi-square and independent t-test compared groups. A total of 976 participants (37.9% males and 62.1% females), 18 years and older, were screened. Mean age was 46.25 ± 17.14 years, BMI was 25.44 ± 5.26 kgm−2, and hemoglobin was 12.04 ± 2.22 g/dL. 3.1% and 12.6% reported existing diagnosis for diabetes and hypertension, respectively. Almost half (47.8%) were overweight/obese; 27.0% were hypertensive while 34.0% had diabetes. Also, 28.8% males compared to 37.8% females had diabetes (P = 0.015), while 28.2% males compared to 26.2% females were hypertensive (P = 0.635). There were differences in BMI (P < 0.0001), anemia (P = 0.007), and undiagnosed diabetes (P < 0.0001) and hypertension (P < 0.0001) by community (Takoradi versus Cape Coast) where the screening took place. Findings from the screening exercise call for improved public health education with a focus on lifestyle habits and health seeking behaviors among Ghanaians.
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Demisse AG, Greffie ES, Abebe SM, Bulti AB, Alemu S, Abebe B, Mesfin N. High burden of hypertension across the age groups among residents of Gondar city in Ethiopia: a population based cross sectional study. BMC Public Health 2017; 17:647. [PMID: 28793889 PMCID: PMC5551023 DOI: 10.1186/s12889-017-4646-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 04/07/2017] [Accepted: 07/28/2017] [Indexed: 01/02/2023] Open
Abstract
Background According to a report on the worldwide trends in blood pressure from 1975 to 2015, mean blood pressure is increasing in low and middle income countries while it is either decreasing or stabilizing in high income countries. Few studies have been published on the prevalence of hypertension in Ethiopia demonstrating an increased trend; however, these studies had small sample size and were limited to participants older than 35 years; which left the burden among adolescents and young adults unaddressed. The aim of this study was to assess prevalence of hypertension (HTN) and associated factors in Gondar city. Method A population based cross-sectional study was conducted among 3227 individuals in Gondar city. A multistage cluster random sampling was used. The Kish method from World Health Organization (WHO) STEPS instrument of random sampling method was used for selecting one individual older than or equal to 18 years from each household. WHO and International Diabetic Association (IDA) criterion was used to classify HTN. Result The overall prevalence of HTN was 27. 4% [95% CI: (25. 8–28.9)]. The prevalence for participants in the age group of ≥35 years was 36. 1%. It consistently increased from 9.5% in the age group of 18–25 years to 46.3% in the age group of ≥65 years (P-value < 0. 001). Only 47% of the participants had ever had any kind of blood pressure measurement. Being elderly (AOR = 5. 56; 95% CI: 3. 71–8. 35), obese (AOR =2. 62; 95%CI: 1. 70–4. 03), widowed (AOR = 1. 87; 95%CI: 1. 27–2. 75), separated (AOR = 1. 87; 95%CI: 1. 27–2. 75), daily alcohol user (AOR = 1. 51; 95%CI: 1. 02–2. 23), male gender (AOR = 1. 42; 95%CI: 1. 18–1. 72) and born in urban area (AOR = 1. 31; 95%CI: 1. 10–1. 56) were found to be independently associated with HTN. Conclusion There is a high prevalence of hypertension in Gondar city and is showing increasing trend compared to previous reports. Interventions to raise awareness and to improve both capacity and accessibility of facilities for screening hypertension are highly recommended.
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Affiliation(s)
- Abayneh Girma Demisse
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Ermias Shenkutie Greffie
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abera Balcha Bulti
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shitaye Alemu
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewketu Abebe
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Mesfin
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mosha NR, Mahande M, Juma A, Mboya I, Peck R, Urassa M, Michael D, Todd J. Prevalence,awareness and factors associated with hypertension in North West Tanzania. Glob Health Action 2017; 10:1321279. [PMID: 28598724 PMCID: PMC5496079 DOI: 10.1080/16549716.2017.1321279] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 01/20/2016] [Accepted: 04/01/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hypertension is a public health problem, and yet few people are aware of it and even fewer access effective treatment. With the ongoing demographic transition in many parts of Sub-Saharan Africa, people are changing from rural, manual work to urban lifestyles, hence the risk of hypertension increases. OBJECTIVE This study aimed at determining the prevalence, awareness and risk factors associated with hypertension in North West Tanzania. DESIGN A community-based cross-sectional study was conducted among adults in Magu District in 2013. Information on socio-demographic, economic and lifestyle characteristics, medical conditions, and risk factors for hypertension were collected according to the WHO Steps survey tool. Measurements of blood pressure, blood sugar, pulse rate, and anthropometry were taken. Multivariate logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with hypertension (Blood pressure ≥140/90mm/Hg). Frequencies and percentages were used to determine the awareness, and treatment among hypertensive participants. RESULTS Among 9678 participants, the prevalence of hypertension was 8.0% and pre-hypertension 36.2%. There was a higher prevalence of hypertension at older ages, among females (8.2%) compared to males (7.7%), and among urban dwellers (10.1%) compared to rural residents (6.8%). Overweight, obese, and diabetic individuals had a higher risk of hypertension while HIV positive participants had a lower risk of hypertension (OR = 0.56; 95% CI 0.39 - 0.79). Among participants with hypertension, awareness was less than 10%. CONCLUSION By integrating blood pressure screening into our long-standing community HIV screening program, we were able to identify many previously undiagnosed cases of hypertension and pre-hypertension. Age, residence, overweight and obesity were the major associated factors for hypertension. Awareness and treatment rates are very low indicating the need for programs to improve awareness, and treatment of hypertension.
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Affiliation(s)
- Neema R. Mosha
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Michael Mahande
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Adinan Juma
- Kilimanjaro Christian Medical Centre, Ministry of Health, Moshi, Tanzania
- Social Welfare, Moshi and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Innocent Mboya
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Rob Peck
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania
| | - Denna Michael
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jim Todd
- National Institute for Medical Research, Mwanza, Tanzania
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Sub-Saharan Africa (SSA) bears the highest burden of both communicable and noncommunicable disease and has the weakest health systems. Much attention is directed toward a rising burden of chronic disease in the setting of epidemiologic transition and urbanization. Indeed, the highest prevalence of hypertension globally is in the World Health Organization's African region at 46% of adults aged 25 and above. And while hypertension in SSA is common, its prevalence varies significantly between urban and rural settings. Although there is evidence for epidemiologic transition in urban areas, there is also evidence of static levels of hypertension within rural areas, which comprise more than 70% of the population of SSA. Furthermore, overall cardiovascular (CV) risk in rural areas remains low. The mean age of hypertensives in SSA is approximately 30s to 40s, burdening those at peak productivity. Complications of hypertension are frequent, given the poor levels of awareness and treatment (<10%) of hypertension on the continent. Such complications include primarily stroke and hypertensive heart disease, as ischemic heart disease is uncommon. Mortality associated with these complications is high, with in-hospital mortality from 2 different sites reported as around 20%. The overall burden of hypertension is likely to be more related to poor access and availability of health systems and is representative of a looming crisis in health care delivery. The best approaches to population-wide treatment are those that utilize CV risk prediction for those with stage 1 hypertension, whereas treatment is generally indicated for all those with stage 2 or greater hypertension, especially in light of the high burden of stroke in SSA. Current guidelines recommend first-line drug therapy with a diuretic or calcium channel blocker. Despite these recommendations, the major obstacles to hypertension treatment are systemic and include the availability and cost of medications, the adequacy of health facilities and systems, and the lack of health insurance to address affordability. New and innovative systems-oriented approaches are needed to address the burden of hypertension on a platform of global equity.
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Ngalesoni FN, Ruhago GM, Mori AT, Robberstad B, Norheim OF. Equity impact analysis of medical approaches to cardiovascular diseases prevention in Tanzania. Soc Sci Med 2016; 170:208-17. [PMID: 27590271 DOI: 10.1016/j.socscimed.2016.08.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 01/07/2023]
Abstract
Primary medical prevention of cardiovascular disease (CVD) has received low priority in Tanzania, despite evidence of the rising prevalence of CVD risk factors. Different guidelines have been proposed for medical CVD prevention, including the European Society of Cardiology (ESC) and the World Health Organization (WHO) guidelines, which recommend medical prevention for all individuals based on the consideration of single CVD risk thresholds. A third alternative is differentiated risk thresholds according to age. This paper compares the WHO and the differentiated risk threshold by age approaches against a baseline of no medical CVD prevention and a best scenario identical to the ESC approach in Tanzania. Assuming fixed budgets, we evaluate the guidelines according to three outcome measures, namely: efficiency, inequality and the combination of efficiency and inequality. We ran a Markov analysis for an estimated Tanzanian population at risk of CVD employing a 40 years time horizon to estimate the total expected costs and CVD deaths associated with provision of the different guidelines. The results were then used to calculate three outcomes: life expectancy at age 40 as a proxy for efficiency, the Gini coefficient (a measure of inequality), and the achievement index (which combines concerns of efficiency and inequality). Our results suggest that higher life expectancy (28.3 vs. 26.6 years) and more equally distributed health (Gini coefficient of 0.22 vs. 0.24) could be attained if medical CVD prevention was based on the differentiated risk threshold approach compared to the WHO single risk threshold, when the total cost of these approaches is the same. Preventing CVD based on differentiating risk thresholds by age seems to be the better alternative when concerns of both efficiency and inequality are considered important. However, further research on the country-specific distribution of CVD risk levels and budget impact analysis are important to assess the feasibility of its implementation.
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Muhamedhussein MS, Nagri ZI, Manji KP. Prevalence, Risk Factors, Awareness, and Treatment and Control of Hypertension in Mafia Island, Tanzania. Int J Hypertens 2016; 2016:1281384. [PMID: 27525113 PMCID: PMC4971322 DOI: 10.1155/2016/1281384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 04/27/2016] [Revised: 06/09/2016] [Accepted: 06/27/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction. The prevalence of hypertension in Africa ranges from 29.7% in Cameroon to 47% in South Africa. Only 10% receive treatment in Cameroon while 32% are on medications in Ghana. Control rates vary from 0.4% to 16.8%. This study was done to assess prevalence, risk factors, awareness, treatment, and control of hypertension in Mafia Island, Tanzania, which has never been documented before, so that necessary interventions can be undertaken accordingly. Methodology. Data was collected through questionnaires and anthropometric measurements were taken. Descriptive statistics were done and potential correlations were analyzed. Results. Out of 570 adults who were included in the study, 154 (27%) were aged 41-50 and the male-to-female ratio was 1 : 1.05. Almost half (49.5%) of the participants fit into the criteria of hypertension. Out of the 118 participants who were aware of having hypertension, 68 (57.6%) were currently taking medication. From those taking medication, only 14 (20.6%) had controlled hypertension. Conclusion. This study tried to show the extent of hypertension and find out risk factors which could explain the high prevalence of hypertension. This is very alarming and a dire need to raise awareness through health education, availability of screening, and treating and follow-up should be given priority.
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Affiliation(s)
| | - Z. I. Nagri
- Shree Hindu Mandal Hospital, P.O. Box 581, Dar es Salaam, Tanzania
| | - K. P. Manji
- Department of Pediatrics and Child health, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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Masalu JR, Åstrøm AN. Predicting Intended and Self-perceived Sugar Restriction among Tanzanian Students using the Theory of Planned Behavior. J Health Psychol 2016; 6:435-45. [DOI: 10.1177/135910530100600406] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examines the applicability and sufficiency of the Theory of Planned Behavior (TPB) in predicting intention and self-perceived behavior with respect to avoiding between-meal intake of sugared snacks and drinks. One thousand one hundred and twenty-three Tanzanian students (mean age 26.4 years) completed self-administered questionnaires designed to measure the components of the TPB during May–July, 1999. Self-perceived sugar consumption was obtained in a subsample of respondents ( n = 228) four weeks later. The TPB provided a significant prediction of intention ( R2= 0.44), with attitude (= 0.25), subjective norms (= 0.28) and perceived behavioral control (= 0.35) significant, and subsequent behavior ( R2 = 0.15, with intention (= 0.25) and perceived behavioral control (= 0.18) significant. Frequency of past behavior explained a significant, albeit small, amount of additional variance in intention (1 percent) and behavior (4 percent). The results indicate that the TPB is applicable to the prediction of food choice-related intention and behavior among young adult students living in a non-occidental setting.
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Mutowo MP, Lorgelly PK, Laxy M, Renzaho AMN, Mangwiro JC, Owen AJ. The Hospitalization Costs of Diabetes and Hypertension Complications in Zimbabwe: Estimations and Correlations. J Diabetes Res 2016; 2016:9754230. [PMID: 27403444 PMCID: PMC4925986 DOI: 10.1155/2016/9754230] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 01/23/2023] Open
Abstract
Objective. Treating complications associated with diabetes and hypertension imposes significant costs on health care systems. This study estimated the hospitalization costs for inpatients in a public hospital in Zimbabwe. Methods. The study was retrospective and utilized secondary data from medical records. Total hospitalization costs were estimated using generalized linear models. Results. The median cost and interquartile range (IQR) for patients with diabetes, $994 (385-1553) mean $1319 (95% CI: 981-1657), was higher than patients with hypertension, $759 (494-1147) mean $914 (95% CI: 825-1003). Female patients aged below 65 years with diabetes had the highest estimated mean costs ($1467 (95% CI: 1177-1828)). Wound care had the highest estimated mean cost of all procedures, $2884 (95% CI: 2004-4149) for patients with diabetes and $2239 (95% CI: 1589-3156) for patients with hypertension. Age below 65 years, medical procedures (amputation, wound care, dialysis, and physiotherapy), the presence of two or more comorbidities, and being prescribed two or more drugs were associated with significantly higher hospitalization costs. Conclusion. Our estimated costs could be used to evaluate and improve current inpatient treatment and management of patients with diabetes and hypertension and determine the most cost-effective interventions to prevent complications and comorbidities.
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Affiliation(s)
- Mutsa P. Mutowo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Paula K. Lorgelly
- Centre for Health Economics, Monash University, Melbourne, VIC 3800, Australia
| | - Michael Laxy
- Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Institute of Health Economics and Health Care Management (IGM), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Andre M. N. Renzaho
- School of Social Science and Psychology, University of Western Sydney, Sydney, NSW 2751, Australia
| | | | - Alice J. Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Ngalesoni FN, Ruhago GM, Mori AT, Robberstad B, Norheim OF. Cost-effectiveness of medical primary prevention strategies to reduce absolute risk of cardiovascular disease in Tanzania: a Markov modelling study. BMC Health Serv Res 2016; 16:185. [PMID: 27184802 PMCID: PMC4869389 DOI: 10.1186/s12913-016-1409-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a growing cause of mortality and morbidity in Tanzania, but contextualized evidence on cost-effective medical strategies to prevent it is scarce. We aim to perform a cost-effectiveness analysis of medical interventions for primary prevention of CVD using the World Health Organization’s (WHO) absolute risk approach for four risk levels. Methods The cost-effectiveness analysis was performed from a societal perspective using two Markov decision models: CVD risk without diabetes and CVD risk with diabetes. Primary provider and patient costs were estimated using the ingredients approach and step-down methodologies. Epidemiological data and efficacy inputs were derived from systematic reviews and meta-analyses. We used disability- adjusted life years (DALYs) averted as the outcome measure. Sensitivity analyses were conducted to evaluate the robustness of the model results. Results For CVD low-risk patients without diabetes, medical management is not cost-effective unless willingness to pay (WTP) is higher than US$1327 per DALY averted. For moderate-risk patients, WTP must exceed US$164 per DALY before a combination of angiotensin converting enzyme inhibitor (ACEI) and diuretic (Diu) becomes cost-effective, while for high-risk and very high-risk patients the thresholds are US$349 (ACEI, calcium channel blocker (CCB) and Diu) and US$498 per DALY (ACEI, CCB, Diu and Aspirin (ASA)) respectively. For patients with CVD risk with diabetes, a combination of sulfonylureas (Sulf), ACEI and CCB for low and moderate risk (incremental cost-effectiveness ratio (ICER) US$608 and US$115 per DALY respectively), is the most cost-effective, while adding biguanide (Big) to this combination yielded the most favourable ICERs of US$309 and US$350 per DALY for high and very high risk respectively. For the latter, ASA is also part of the combination. Conclusions Medical preventive cardiology is very cost-effective for all risk levels except low CVD risk. Budget impact analyses and distributional concerns should be considered further to assess governments’ ability and to whom these benefits will accrue.
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Affiliation(s)
- Frida N Ngalesoni
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania. .,Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway.
| | - George M Ruhago
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway
| | - Amani T Mori
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Centre of International Health, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Centre of International Health, University of Bergen, Bergen, Norway
| | - Ole F Norheim
- Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway
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Michael D, Kezakubi D, Juma A, Todd J, Reyburn H, Renju J. The feasibility and acceptability of screening for hypertension in private drug retail outlets: a pilot study in Mwanza region, Tanzania. Int Health 2016; 8:360-6. [PMID: 27170761 PMCID: PMC5039818 DOI: 10.1093/inthealth/ihw023] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/10/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypertension is a major contributor to ill health in sub-Saharan Africa. Developing countries need to increase access for screening. This study assesses the feasibility and acceptability of using private sector drug retail outlets to screen for hypertension in Mwanza region, Tanzania. METHODS A pilot study took place in eight drug retail outlets from August 2013 to February 2014. Customers ≥18 years were invited for screening. Socio-demographic characteristics, hypertension knowledge, hypertension screening and treatment history were collected. Subjects with systolic blood pressure over 140 mmHg were referred for follow up. Referral slips captured attendance. Mystery client visits and follow up phone calls were conducted to assess service quality. RESULTS A total of 971 customers were screened, one person refused; 109 (11.2%) had blood pressure over 140/90 mmHg and were referred for ongoing assessment; 85/109 (78.0%) were newly diagnosed. Customers reported that the service was acceptable. Service providers were able to follow the protocol. Only 18/85 (21%) newly diagnosed participants visited the referral clinic within two weeks. CONCLUSIONS Blood pressure screening was feasible and acceptable to customers of private drug retail outlets. However many who were referred failed to attend at a referral centre and further research is needed in this area.
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Affiliation(s)
- Denna Michael
- National Institute of Medical Research, Isamilo Road, P.O. Box 1462, Mwanza, Tanzania
| | - Dotto Kezakubi
- National Institute of Medical Research, Isamilo Road, P.O. Box 1462, Mwanza, Tanzania
| | - Adinan Juma
- Kilimanjaro Christian Medical University College (Tumaini University), Department of Epidemiology and Biostatistics, P.O. Box 2240, Moshi, Tanzania
| | - Jim Todd
- The London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hugh Reyburn
- The London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Jenny Renju
- Kilimanjaro Christian Medical University College (Tumaini University), Department of Epidemiology and Biostatistics, P.O. Box 2240, Moshi, Tanzania The London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Abstract
The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behaviour, risk and disease, which implicitly locates 'risk' within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with 'alternative' environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralise health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralising health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualising strategies that may address both behavioural and structural determinants of health.
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Affiliation(s)
- Shanti Nulu
- a Department of Medicine , Yale University , New Haven , CT , USA
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31
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Sarki AM, Nduka CU, Stranges S, Kandala NB, Uthman OA. Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e1959. [PMID: 26683910 PMCID: PMC5058882 DOI: 10.1097/md.0000000000001959] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 11/26/2022] Open
Abstract
We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries.
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Affiliation(s)
- Ahmed M Sarki
- From the Division of Health Sciences, University of Warwick Medical School, Coventry, UK (AMS, CUN); Family and Youth Health Initiative (FAYOHI), Nigeria (AMS); Department of Population Health, Luxembourg Institute of Health, Luxembourg (SS, N-BK); Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of health Sciences, University of Warwick Medical School, Coventry, UK (OAU); and Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK (OAU); Department of Mathematics and Information sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK (N-BK)
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Akinlua JT, Meakin R, Umar AM, Freemantle N. Current Prevalence Pattern of Hypertension in Nigeria: A Systematic Review. PLoS One 2015; 10:e0140021. [PMID: 26461923 PMCID: PMC4603956 DOI: 10.1371/journal.pone.0140021] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/19/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The global burden of hypertension and other non-communicable diseases (NCDs) is rapidly increasing, and the African continent seems to be the most affected region in the world. The prevalence of hypertension in Nigeria forms a substantial portion of the total burden in Africa because of the large population of the country currently estimated to be over 170 million. OBJECTIVE The purpose of this systematic review is to summarise up to date data on the prevalence and distribution of hypertension in Nigeria from prevalence studies. METHODS A search of the following databases: PubMed, EMBase and WHO cardiovascular InfoBase from 1968 till date was conducted to identify studies which provide estimates of prevalence of hypertension in Nigeria. RESULTS The search yielded a total of 1748 hits from which 45 relevant studies met the inclusion criteria for the review. The overall crude prevalence of hypertension ranged from 0.1% (95%CI:-0.1 to 0.3) to 17.5% (95% CI: 13.6 to 21.4) in children and 2.1% (95%CI: 1.4 to 2.8) to 47.2% (95%CI: 43.6 to 50.8) in adults depending on the benchmark used for diagnosis of hypertension, the setting in which the study was conducted, sex and ethnic group. The crude prevalence of hypertension ranged from 6.2% (95%CI: 4.0 to 8.4) to 48.9% (95%CI: 42.3 to 55.5) for men and 10% (95%CI: 8.1 to 12) to 47.3% (95%CI: 43 to 51.6%) for women. In most studies, prevalence of hypertension was higher in males than females. In addition, prevalence across urban and rural ranged from 9.5% (95%CI: 13.6 to 21.4) to 51.6% (95%CI: 49.8 to 53.4) and 4.8% (95%CI: 2.9 to 6.7) to 43% (95%CI: 42.1 to 43.9) respectively. CONCLUSIONS The prevalence of hypertension is high among the Nigerian population. Appropriate interventions need to be developed and implemented to reduce the preventable burden of hypertension especially at Primary Health Care Centres which is the first point of call for over 55% of the Nigerian population.
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Affiliation(s)
- James Tosin Akinlua
- Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), Rowland Hill street, London, NW3 2PF, United Kingdom
| | - Richard Meakin
- Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), Rowland Hill street, London, NW3 2PF, United Kingdom
| | - Aminu Mahmoud Umar
- College of Science and Technology, University of Salford, Salford Crescent, Manchester, M5 4WT, United Kingdom
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), Rowland Hill street, London, NW3 2PF, United Kingdom
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Guwatudde D, Mutungi G, Wesonga R, Kajjura R, Kasule H, Muwonge J, Ssenono V, Bahendeka SK. The Epidemiology of Hypertension in Uganda: Findings from the National Non-Communicable Diseases Risk Factor Survey. PLoS One 2015; 10:e0138991. [PMID: 26406462 PMCID: PMC4583385 DOI: 10.1371/journal.pone.0138991] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [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: 06/23/2015] [Accepted: 09/08/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hypertension is an important contributor to global burden of disease and mortality, and is a growing public health problem in sub-Saharan Africa. However, most sub-Saharan African countries lack detailed countrywide data on hypertension and other non-communicable diseases (NCD) risk factors that would provide benchmark information for design of appropriate interventions. We analyzed blood pressure data from Uganda's nationwide NCD risk factor survey conducted in 2014, to describe the prevalence and distribution of hypertension in the Ugandan population, and to identify the associated factors. METHODS The NCD risk factor survey drew a countrywide sample stratified by the four regions of the country, and with separate estimates for rural and urban areas. The World Health Organization's STEPs tool was used to collect data on demographic and behavioral characteristics, and physical and biochemical measurements. Prevalence rate ratios (PRR) using modified Poison regression modelling was used to identify factors associated with hypertension. RESULTS Of the 3906 participants, 1033 were classified as hypertensive, giving an overall prevalence of 26.4%. Prevalence was highest in the central region at 28.5%, followed by the eastern region at 26.4%, western region at 26.3%, and northern region at 23.3%. Prevalence in urban areas was 28.9%, and 25.8% in rural areas. The differences between regions, and between rural-urban areas were not statistically significant. Only 7.7% of participants with hypertension were aware of their high blood pressure. The prevalence of pre-hypertension was also high at 36.9%. The only modifiable factor found to be associated with hypertension was higher body mass index (BMI). Compared to participants with BMI less than 25 kg/m2, prevalence was significantly higher among participants with BMI between 25 to 29.9 kg/m2 with an adjusted PRR = 1.46 [95% CI = 1.25-1.71], and even higher among obese participants (BMI ≥ 30 kg/m2) with an adjusted PRR = 1.60 [95% CI = 1.29-1.99]. The un-modifiable factor found to be associated with hypertension was older age with an adjusted PRR of 1.02 [95% CI = 1.02-1.03] per yearly increase in age. CONCLUSIONS The prevalence of hypertension in Uganda is high, with no significant differences in distribution by geographical location. Only 7.7% of persons with hypertension were aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure. Thus a big percentage of persons with hypertension are at high risk of hypertension-related cardiovascular NCDs.
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Affiliation(s)
- David Guwatudde
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gerald Mutungi
- Control of Non-Communicable Diseases Desk, Ministry of Health, Kampala, Uganda
| | - Ronald Wesonga
- School of Statistics and Planning, Makerere University College of Business and Management Sciences, Kampala, Uganda
| | - Richard Kajjura
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hafisa Kasule
- World Health Organization, Uganda Country Office, Kampala, Uganda
| | - James Muwonge
- Division of Socioeconomic Surveys, Uganda Bureau of Statistics, Kampala, Uganda
| | - Vincent Ssenono
- Division of Socioeconomic Surveys, Uganda Bureau of Statistics, Kampala, Uganda
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Yazdanpanah L, Shahbazian H, Shahbazian H, Latifi SM. Prevalence, awareness and risk factors of hypertension in southwest of Iran. J Renal Inj Prev 2015; 4:51-6. [PMID: 26060838 PMCID: PMC4459729 DOI: 10.12861/jrip.2015.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/04/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction: Hypertension is an important cause of stroke, heart and kidney disease and these diseases are the cause for about two-thirds of all mortalities around the world.
Objectives: The aim of this study was to assess the prevalence, awareness and risk factors of hypertension in Ahvaz, southwest of Iran.
Patients and Methods: In this descriptive-analytical study, 944 participants older than 20 years were enrolled. Systolic blood pressure (BP) ≥140 mm Hg, diastolic BP ≥90 mm Hg or the use of antihypertensive medication was considered as hypertension. Systolic BP = 140-159 mm Hg or diastolic BP = 90-99 mm Hg were defined as stage 1, and systolic BP ≥160 mm Hg or diastolic BP ≥100 mm Hg were considered as stage 2 of hypertension. Systolic BP = 120-139 mm Hg and diastolic BP= 80-89 mm Hg were considered as prehypertensive state.
Results: The prevalence of hypertension in Ahvaz was 17.58% (95% CI: 15.28-20.14) (males; 45.8%, females; 54.2%). Age-adjusted prevalence of hypertension was 8.6%; age- and sex-adjusted prevalence of hypertension was 3.7%. Seventy-two cases (7.7%) were prehypertensive. The frequency of stage 1 hypertension was 10.8% and stage 2 was 5.7%. Among them, 53.6% were not aware of their disease and 22% of hypertensive cases were controlled. Logistic regression analysis showed that age, metabolic syndrome and family history of hypertension had significant relationship with hypertension.
Conclusion: This study showed that, age, metabolic syndrome and family history of disease are risk factors of hypertension in Ahvaz population. About half of patients were unaware of their disease and about 20% had controlled BP.
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Affiliation(s)
- Leila Yazdanpanah
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hajieh Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Heshmatollah Shahbazian
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed-Mahmuod Latifi
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Walker RW, Viney R, Green L, Mawanswila M, Maro VP, Gjertsen C, Godfrey H, Smailes R, Gray WK. Trends in stroke admissions to a Tanzanian hospital over four decades: a retrospective audit. Trop Med Int Health 2015; 20:1290-6. [PMID: 25983015 DOI: 10.1111/tmi.12547] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to record stroke admissions to a tertiary referral hospital in Tanzania over four decades. METHODS We audited the medical records held at a large teaching and tertiary referral hospital in northern Tanzania over four decades. We collected records for the years 1974-1976, 1984-1986, 1994-1995 and 2008. All patients admitted as inpatients with a primary diagnosis of stroke were included in the study. Data collected included age, sex, stroke subtype, predominant side of symptoms and survival to discharge. RESULTS The number of stroke admissions rose from just four in the three-year period 1974-1976 (mean 1.3 cases annually) to 153 cases annually in 2008. The mean age of those admitted rose steadily during this period, as did the proportion of females admitted. CONCLUSIONS The burden of stroke on health services in Tanzania appears to have increased rapidly. If this increase is to be slowed, then sustainable primary preventative measures to target known stroke risk factors will be required.
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Affiliation(s)
- Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Viney
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Green
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | - Hannah Godfrey
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Rosanna Smailes
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
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Anteneh ZA, Yalew WA, Abitew DB. Prevalence and correlation of hypertension among adult population in Bahir Dar city, northwest Ethiopia: a community based cross-sectional study. Int J Gen Med 2015; 8:175-85. [PMID: 26005357 PMCID: PMC4427605 DOI: 10.2147/ijgm.s81513] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 11/23/2022] Open
Abstract
BACKGROUND Hypertension is one of the most common causes of premature death and morbidity and has a major impact on health care costs. It is an important public health challenge to both developed and developing countries. The aim of this study was to determine the magnitude and correlates of hypertension. METHODS A community-based cross-sectional study was conducted in June 2014 among 681 adult residents of Bahir Dar city using multistage sampling techniques. An interview-administrated questionnaire and physical measurements such as blood pressure (BP), weight, height, and waist and hip circumferences were employed to collect the data. The data were coded, entered, and analyzed with SPSS version 16 software package. RESULTS A total of 678 responses were included in the analysis resulting in a response rate of 99.6%. The findings declared that 17.6%, 19.8%, and 2.2% of respondents were prehypertension, hypertension stage I, and hypertension stage II, respectively, on screening test. The overall prevalence of hypertension (systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or known hypertensive patient taking medications) was 25.1%. According to the multivariate logistic regression analysis, age; having ever smoked cigarette; number of hours spent walking/cycling per day; number of hours spent watching TV per day; history of diabetes; adding salt to food in addition to the normal amount that is added to the food during cooking; and body mass index were statistically significant predictors of hypertension. CONCLUSION One out of every four respondents of the study had hypertension, and more than one out of three cases of hypertension (38.8%) did not know that they had the hypertension; 17.6% of the respondents were in prehypertension stage, which adds to overall future risk of hypertension. Therefore, mass screening for hypertension, health education to prevent substance use, regular exercise, reducing salt consumption, and life style modifications are recommended.
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Affiliation(s)
- Zelalem Alamrew Anteneh
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Worku Awoke Yalew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dereje Birhanu Abitew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Maar M, Yeates K, Barron M, Hua D, Liu P, Moy Lum-Kwong M, Perkins N, Sleeth J, Tobe J, Wabano MJ, Williamson P, Tobe SW. I-RREACH: an engagement and assessment tool for improving implementation readiness of researchers, organizations and communities in complex interventions. Implement Sci 2015; 10:64. [PMID: 25935849 PMCID: PMC4424962 DOI: 10.1186/s13012-015-0257-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 09/23/2014] [Accepted: 04/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable chronic diseases are the leading causes of mortality globally, and nearly 80% of these deaths occur in low- and middle-income countries (LMICs). In high-income countries (HICs), inequitable distribution of resources affects poorer and otherwise disadvantaged groups including Aboriginal peoples. Cardiovascular mortality in high-income countries has recently begun to fall; however, these improvements are not realized among citizens in LMICs or those subgroups in high-income countries who are disadvantaged in the social determinants of health including Aboriginal people. It is critical to develop multi-faceted, affordable and realistic health interventions in collaboration with groups who experience health inequalities. Based on community-based participatory research (CBPR), we aimed to develop implementation tools to guide complex interventions to ensure that health gains can be realized in low-resource environments. METHODS We developed the I-RREACH (Intervention and Research Readiness Engagement and Assessment of Community Health Care) tool to guide implementation of interventions in low-resource environments. We employed CBPR and a consensus methodology to (1) develop the theoretical basis of the tool and (2) to identify key implementation factor domains; then, we (3) collected participant evaluation data to validate the tool during implementation. RESULTS The I-RREACH tool was successfully developed using a community-based consensus method and is rooted in participatory principles, equalizing the importance of the knowledge and perspectives of researchers and community stakeholders while encouraging respectful dialogue. The I-RREACH tool consists of three phases: fact finding, stakeholder dialogue and community member/patient dialogue. The evaluation for our first implementation of I-RREACH by participants was overwhelmingly positive, with 95% or more of participants indicating comfort with and support for the process and the dialogue it creates. CONCLUSIONS The I-RREACH tool was designed to (1) pinpoint key domains required for dialogue between the community and the research team to facilitate implementation of complex health interventions and research projects and (2) to identify existing strengths and areas requiring further development for effective implementation. I-RREACH has been found to be easily adaptable to diverse geographical and cultural settings and can be further adapted to other complex interventions. Further research should include the potential use of the I-RREACH tool in the development of blue prints for scale-up of successful interventions, particularly in low-resource environments.
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Affiliation(s)
- Marion Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada.
| | - Karen Yeates
- Department of Medicine, Queens University, Kingston, ON, Canada.
| | | | - Diane Hua
- Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | - Margaret Moy Lum-Kwong
- Department of Research, Advocacy and Health Promotion, Heart and Stroke Foundation of Ontario, Toronto, ON, Canada.
| | - Nancy Perkins
- Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
| | - Jessica Sleeth
- Department of Medicine, Queens University, Kingston, ON, Canada.
| | - Joshua Tobe
- Department of Medicine, Western University, London, ON, Canada.
| | | | | | - Sheldon W Tobe
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada.
- Department of Nephrology, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
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Makubi A, Hage C, Lwakatare J, Mmbando B, Kisenge P, Lund LH, Rydén L, Makani J. Prevalence and prognostic implications of anaemia and iron deficiency in Tanzanian patients with heart failure. Heart 2015; 101:592-9. [PMID: 25539945 PMCID: PMC5573172 DOI: 10.1136/heartjnl-2014-306890] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To determine the prevalence, correlates and prognostic implications of anaemia and iron deficiency (ID) in patients with heart failure (HF) in Tanzania. METHOD This was a cross-sectional and prospective observational study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were ≥ 18 years of age, with HF defined according to the Framingham criteria. The primary outcome was anaemia and the secondary outcome was a composite of hospitalisation for HF or all-cause mortality. RESULTS A total of 401 HF patients (median age 56 years, IQR 41-67 years; women 51%) were included. The prevalence of anaemia was 57%. The overall prevalence of ID was 49% distributed as 69% versus 21% in subjects with and without anaemia (p < 0.001). Normocytic anaemia was seen in 18% of the patients while none had macrocytic anaemia. The risk of having anaemia was positively associated with residency outside Dar es Salaam (OR 1.72 (95% CI 1.02 to 2.89); p = 0.038), atrial fibrillation (4.12 (1.60 to 10.61); p=0.003), LVEF < 45% (2.70 (1.57 to 4.67); p < 0.001) and negatively (ORs per unit decrease) with creatinine clearance (0.98 (0.97 to 0.99); p = 0.012) and total cholesterol (0.78 (0.63 to 0.98); p = 0.029). One-year survival free from a composite endpoint was 70%. The presence of ID anaemia increased the likelihood for an event (HR 2.67; 95% CI 1.39 to 5.07; p = 0.003), while anaemia without ID did not influence the risk. CONCLUSIONS ID anaemia was common in Tanzanian patients with HF and was independently associated with the risk for hospitalisation or death.
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Affiliation(s)
- Abel Makubi
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Camilla Hage
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Johnson Lwakatare
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Bruno Mmbando
- National Institute of Medical Research, Tanga Centre, Tanzania
- Muhimbili Wellcome Programme, Dar es Salaam, Tanzania
| | - Peter Kisenge
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Lars H Lund
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Julie Makani
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Muhimbili Wellcome Programme, Dar es Salaam, Tanzania
- Nuffield Department of Clinical Medicine, University of Oxford, London, UK
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Abstract
The burden of hypertension in Sub-Saharan Africa has been increasing over the past few decades. However, a large proportion of the population with hypertension remains undiagnosed, untreated, or inadequately treated, contributing to the rising burden of cardiovascular disease in the region. We conducted a systematic review and meta-analysis to assess the recent burden of hypertension in Sub-Saharan Africa, based on studies published between 2000 and 2013. We pooled data from 33 surveys involving over 110 414 participants of mean age 40 years. Hypertension prevalence varied widely across the studies (range 15%–70%), partly because of differences in participant mean ages (31–76 years). The predicted prevalence of hypertension at mean participant ages of 30, 40, 50, and 60 years were 16%, 26%, 35%, and 44%, respectively, with a pooled prevalence of 30% (95% confidence interval, 27%–34%). Of those with hypertension, only between 7% and 56% (pooled prevalence: 27%; 95% confidence interval, 23%–31%) were aware of their hypertensive status before the surveys. Overall, 18% (95% confidence interval, 14%–22%) of individuals with hypertension were receiving treatment across the studies, and only 7% (95% confidence interval, 5%–8%) had controlled blood pressure. This review found a high prevalence of hypertension, as well as low percentage of hypertension awareness, treatment, and control in Sub-Saharan Africa, highlighting the need for implementation of timely and appropriate strategies for diagnosis, control, and prevention.
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Affiliation(s)
- Feven Ataklte
- From the Department of Medicine, Kings College London, London, UK (F.A.); Department of Medicine, Weill Cornell Medical College, New York, NY (S.E.); Veteran Affairs Pittsburgh Health Care System, PA (S.E.); Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (S.K.); Department of Medicine, Jamaica Medical Center, New York, NY (B.T.); Hubert Department of Public Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); MedStar Health,
| | - Sebhat Erqou
- From the Department of Medicine, Kings College London, London, UK (F.A.); Department of Medicine, Weill Cornell Medical College, New York, NY (S.E.); Veteran Affairs Pittsburgh Health Care System, PA (S.E.); Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (S.K.); Department of Medicine, Jamaica Medical Center, New York, NY (B.T.); Hubert Department of Public Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); MedStar Health,
| | - Stephen Kaptoge
- From the Department of Medicine, Kings College London, London, UK (F.A.); Department of Medicine, Weill Cornell Medical College, New York, NY (S.E.); Veteran Affairs Pittsburgh Health Care System, PA (S.E.); Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (S.K.); Department of Medicine, Jamaica Medical Center, New York, NY (B.T.); Hubert Department of Public Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); MedStar Health,
| | - Betiglu Taye
- From the Department of Medicine, Kings College London, London, UK (F.A.); Department of Medicine, Weill Cornell Medical College, New York, NY (S.E.); Veteran Affairs Pittsburgh Health Care System, PA (S.E.); Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (S.K.); Department of Medicine, Jamaica Medical Center, New York, NY (B.T.); Hubert Department of Public Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); MedStar Health,
| | - Justin B. Echouffo-Tcheugui
- From the Department of Medicine, Kings College London, London, UK (F.A.); Department of Medicine, Weill Cornell Medical College, New York, NY (S.E.); Veteran Affairs Pittsburgh Health Care System, PA (S.E.); Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (S.K.); Department of Medicine, Jamaica Medical Center, New York, NY (B.T.); Hubert Department of Public Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); MedStar Health,
| | - Andre P. Kengne
- From the Department of Medicine, Kings College London, London, UK (F.A.); Department of Medicine, Weill Cornell Medical College, New York, NY (S.E.); Veteran Affairs Pittsburgh Health Care System, PA (S.E.); Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (S.K.); Department of Medicine, Jamaica Medical Center, New York, NY (B.T.); Hubert Department of Public Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); MedStar Health,
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Helelo TP, Gelaw YA, Adane AA. Prevalence and associated factors of hypertension among adults in Durame Town, Southern Ethiopia. PLoS One 2014; 9:e112790. [PMID: 25415321 PMCID: PMC4240541 DOI: 10.1371/journal.pone.0112790] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022] Open
Abstract
Background To date, non-communicable diseases, such as cardiovascular diseases, are becoming severe public health challenges particularly in developing countries. Hypertension is a modifiable risk factor that contributes the leading role for mortality. The problem is significant in low- and middle-income countries like sub-Saharan Africa. However, there are limited studies in developing countries, particularly in Ethiopia. Hence, determining the magnitude of hypertension and identifying risk groups are important. Methods A community based cross sectional study was conducted in April 2013 among adults (age>31 years) old. A systematic sampling technique was used to select a total of 518 study participants. Data were collected after full verbal informed consent was obtained from each participant. Multivariable logistic regressions were fitted to control the effect of confounding. Adjusted Odds ratios (OR) with their 95% confidence intervals (95% CI) were calculated to measure associations. Variables having P-value <0.05 were considered as significant. Results The overall prevalence of hypertension in Durame town was 22.4% (95% CI: 18.8–26.0). Nearly 40% of hypertensive patients were newly screened. Male sex [AOR = 2.03, 95% CI; 1.05–3.93], age [AOR = 29.49, 95% CI; 10.60–81.27], salt use [AOR = 6.55, 95% CI; 2.31–18.53], eating vegetable three or fewer days per week [AOR = 2.3,95% CI; 1.17–4.51], not continuously walking at least for 10 minutes per day [AOR = 7.82, 95% CI; 2.37–25.82], having family history of hypertension [AOR = 2.46, 95%CI; 1.31–4.61] and being overweight/obese [AOR = 15.7, 95% CI 7.89–31.21)] were found to be risk factors for hypertension. Conclusions The prevalence of hypertension is found to be high. Older age, male sex, having family history of hypertension, physical inactivity, poor vegetable diet, additional salt consumption and obesity were important risk factors associated with hypertension among adults. Community level intervention measures with a particular emphasis on prevention by introducing lifestyle modifications are recommended.
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Affiliation(s)
- Tsegab Paulose Helelo
- Zonal Health Department, Southern Nations Nationalities and People's Health Bureau, Durame, Ethiopia
- * E-mail:
| | - Yalemzewod Assefa Gelaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Akilew Awoke Adane
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ngalesoni F, Ruhago G, Norheim OF, Robberstad B. Economic cost of primary prevention of cardiovascular diseases in Tanzania. Health Policy Plan 2014; 30:875-84. [PMID: 25113027 PMCID: PMC4524339 DOI: 10.1093/heapol/czu088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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] [Accepted: 07/02/2014] [Indexed: 12/15/2022] Open
Abstract
Tanzania is facing a double burden of disease, with non-communicable diseases being an increasingly important contributor. Evidence-based preventive measures are important to limit the growing financial burden. This article aims to estimate the cost of providing medical primary prevention interventions for cardiovascular disease (CVD) among at-risk patients, reflecting actual resource use and if the World Health Organization (WHO)’s CVD medical preventive guidelines are implemented in Tanzania. In addition, we estimate and explore the cost to patients of receiving these services. Cost data were collected in four health facilities located in both urban and rural settings. Providers’ costs were identified and measured using ingredients approach to costing and resource valuation followed the opportunity cost method. Unit costs were estimated using activity-based and step-down costing methodologies. The patient costs were obtained through a structured questionnaire. The unit cost of providing CVD medical primary prevention services ranged from US$30–41 to US$52–71 per patient per year at the health centre and hospital levels, respectively. Employing the WHO’s absolute risk approach guidelines will substantially increase these costs. The annual patient cost of receiving these services as currently practised was estimated to be US$118 and US$127 for urban and rural patients, respectively. Providers’ costs were estimated from two main viewpoints: ‘what is’, that is the current practice, and ‘what if’, reflecting a WHO guidelines scenario. The higher cost of implementing the WHO guidelines suggests the need for further evaluation of whether these added costs are reasonable relative to the added benefits. We also found considerably higher patient costs, implying that distributive and equity implications of access to care require more consideration. Facility location surfaced as the main explanatory variable for both direct and indirect patient costs in the regression analysis; further research on the influence of other provider characteristics on these costs is important.
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Affiliation(s)
- Frida Ngalesoni
- Ministry of Health and Social Welfare, PO Box 9083 Dar es Salaam, Tanzania, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway,
| | - George Ruhago
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway, School of Public Health and Social Sciences, Muhimbili University, PO Box 65015 Dar es Salaam, Tanzania and
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, PO Box 7804, N-5020, Bergen, Norway
| | - Bjarne Robberstad
- Center of International Health, University of Bergen, PO Box 7804, N-5020, Bergen, Norway
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Abstract
Background The burden of hypertension is high in Africa, and due to rapid population growth and ageing, the exact burden on the continent is still far from being known. We aimed to estimate the prevalence and awareness rates of hypertension in Africa based on the cut off “≥140/90 mm Hg”. Methods We conducted a systematic search of Medline, EMBASE and Global Health. Search date was set from January 1980 to December 2013. We included population-based studies on hypertension, conducted among people aged ≥15 years and providing numerical estimates on the prevalence of hypertension in Africa. Overall pooled prevalence of hypertension in mixed, rural and urban settings in Africa were estimated from reported crude prevalence rates. A meta-regression epidemiological modelling, using United Nations population demographics for the years 1990, 2000, 2010 and 2030, was applied to determine the prevalence rates and number of cases of hypertension in Africa separately for these four years. Results Our search returned 7680 publications, 92 of which met the selection criteria. The overall pooled prevalence of hypertension in Africa was 19.7% in 1990, 27.4% in 2000 and 30.8% in 2010, each with a pooled awareness rate (expressed as percentage of hypertensive cases) of 16.9%, 29.2% and 33.7%, respectively. From the modelling, over 54.6 million cases of hypertension were estimated in 1990, 92.3 million cases in 2000, 130.2 million cases in 2010, and a projected increase to 216.8 million cases of hypertension by 2030; each with an age-adjusted prevalence of 19.1% (13.9, 25.5), 24.3% (23.3, 31.6), 25.9% (23.5, 34.0), and 25.3% (24.3, 39.7), respectively. Conclusion Our findings suggest the prevalence of hypertension is increasing in Africa, and many hypertensive individuals are not aware of their condition. We hope this research will prompt appropriate policy response towards improving the awareness, control and overall management of hypertension in Africa.
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Affiliation(s)
- Davies Adeloye
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Midlothian, United Kingdom
- * E-mail:
| | - Catriona Basquill
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Midlothian, United Kingdom
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Macia E, Duboz P, Gueye L. [Arterial hypertension in Dakar: Prevalence, awareness, treatment, and control]. ACTA ACUST UNITED AC 2014; 108:49-56. [PMID: 24928298 DOI: 10.1007/s13149-014-0369-2] [Citation(s) in RCA: 2] [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: 01/16/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study was to determine prevalence, awareness, treatment, and control of hypertension, and its risk factors in Dakar. Six hundred people aged 20 and older, living in the city of Dakar were interviewed. This sample was constructed using the combined quota method in order to strive to representativeness of the target population. Prevalence of hypertension was 27.50%. Quarter of those suffering from high blood pressure were aware of their problem, and among the latter, 61% said they were on treatment. However, of these, only 32% had controlled arterial blood pressure, that is less than 6% of those suffering from hypertension. Two factors were associated with hypertension, awareness, and treatment: age and the frequency of doctor visits. These results indicate that hypertension already constitutes a major health concern in the Senegalese capital. Detection can be considerably improved given that only a quarter of the hypertensives are aware of this problem. Compliance with treatments also appears particularly problematic. Public health policies should be quickly set up to minimize the consequences of this emerging burden.
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Affiliation(s)
- E Macia
- UMI 3189 Environnement, santé, sociétés (Université Cheikh Anta Diop / CNRS / Université de Bamako / CNRST Burkina-Faso, Dakar, Senegal.
| | - P Duboz
- UMI 3189 Environnement, santé, sociétés (Université Cheikh Anta Diop / CNRS / Université de Bamako / CNRST Burkina-Faso, Dakar, Senegal
| | - L Gueye
- UMI 3189 Environnement, santé, sociétés (Université Cheikh Anta Diop / CNRS / Université de Bamako / CNRST Burkina-Faso, Dakar, Senegal
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Mengistu MD. Pattern of blood pressure distribution and prevalence of hypertension and prehypertension among adults in Northern Ethiopia: disclosing the hidden burden. BMC Cardiovasc Disord 2014; 14:33. [PMID: 24592854 PMCID: PMC3973867 DOI: 10.1186/1471-2261-14-33] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 11/04/2013] [Accepted: 02/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension is the 3rd cause of death accounting for one in eight deaths worldwide. Hypertension was thought to be rare in Africa, but it is now recognized as one of the most important cerebrovascular diseases contributing to about 40% of these diseases in the continent.The aims of this study were to describe the pattern of blood pressure distribution among adults, and determine prevalence of prehypertension and hypertension among adults in Northern Ethiopia. METHOD The study was done on a community-based sample of 1183 adults of 697 (58.8%) urban and 486 (41.1%) rural residents using statistical multistage sampling procedures. The study was based on the recent WHO and JNC-7 classification of blood pressure. Multi-item structured questionnaires were also developed to elicit additional information on the subjects. RESULTS The overall prevalence of hypertension and prehypertension in the study population was 18.1% and 37.2%, respectively. The prevalence of hypertension positively correlated with body mass index and age in both urban and rural residents (P = 0.001). Sex and age adjusted mean systolic blood pressure (SBP) was statistically higher in urban than in rural population (P = 0.001). CONCLUSION Hypertension was found to have high prevalence in the study region. However, people's awareness and control of hypertension was found to be very poor. Lack of a clear hypertension prevention guidelines and strategies nationwide can aggravate the impact of cardiovascular diseases.
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Affiliation(s)
- Mekoya D Mengistu
- Department of Physiology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
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Duboz P, Boëtsch G, Gueye L, Macia E. Hypertension prevalence, awareness, treatment and control in Dakar (Senegal). J Hum Hypertens 2014; 28:489-93. [PMID: 24430710 DOI: 10.1038/jhh.2013.142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/26/2013] [Accepted: 12/02/2013] [Indexed: 01/16/2023]
Abstract
The prediction of risk profile trends associated with non-communicable diseases in developing countries is among the greatest global health challenges. The aim of this study is to estimate prevalence, awareness, treatment and control of hypertension in Dakar (Senegal). This study was carried out between January and June 2009 on a population sample of 600 individuals living in the department of Dakar. This sample was constructed using the quota method in order to strive for representativeness. Sociodemographic characteristics, hypertension, hypertension awareness, treatment and control, and body mass index of individuals were collected during face-to-face interviews. Statistical analyses used were χ2-tests and binary logistic regressions. Prevalence of hypertension was 27.50%. Prevalence of awareness, treatment and control among hypertensives were 27.88%, 16.97% and 5.45%, respectively. Logistic regression showed that the prevalence, awareness and treatment of hypertension increased with increasing age. Overweight and obese subjects were more often hypertensive but did not differ from others in awareness and treatment. This could be linked to the social valorization of stoutness in West Africa, which explains that excess weight is not perceived as a risk factor for hypertension. In conclusion, given the very low rates of awareness, treatment and control in our sample, developing strategies for averting a hypertension epidemic must be a priority objective.
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Affiliation(s)
- P Duboz
- UMR 7268 ADèS, Aix-Marseille Université/EFS/CNRS, Faculté de Médecine Secteur Nord, Boulevard Pierre Dramard, Marseille, France
| | - G Boëtsch
- UMI 3189 Environnement, Santé, Sociétés, CNRS/Université Cheikh Anta Diop/Université de Bamako/CNRST, Laboratoire de Physiologie exploratoire et fonctionnelle, Faculté de Médecine de Dakar, Université Cheikh Anta Diop, Dakar, Senegal
| | - L Gueye
- UMI 3189 Environnement, Santé, Sociétés, CNRS/Université Cheikh Anta Diop/Université de Bamako/CNRST, Laboratoire de Physiologie exploratoire et fonctionnelle, Faculté de Médecine de Dakar, Université Cheikh Anta Diop, Dakar, Senegal
| | - E Macia
- UMI 3189 Environnement, Santé, Sociétés, CNRS/Université Cheikh Anta Diop/Université de Bamako/CNRST, Laboratoire de Physiologie exploratoire et fonctionnelle, Faculté de Médecine de Dakar, Université Cheikh Anta Diop, Dakar, Senegal
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Abstract
BACKGROUND Hypertension is the leading cause of death in the world and is the commonest cause for outpatient visits to physicians. The objective of this study was to assess the prevalence of hypertension and its risk factors among adults in Bedele Town, South-west Ethiopia. METHOD A community-based cross-sectional survey was conducted by interviewing participants regarding their socio-demographic characteristics, history of hypertension, its risk factors and knowledge of its complications and treatment. Measurements of their blood pressure, body weight, height, and waist circumferences were also done on the same day. The data were analyzed using SPSS Version 16 statistical software. Chi-square test and odds ratio with 95% CI were used to assess the association between dependent and independent variables. Logistic regression model was used to determine the independent risk factors for hypertension. P-values of < 0.05 were considered statistically significant. RESULTS A total of 396 adults of whom 67.4% were males participated in the study. Prevalence of hypertension, defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥ 90 mmHg or reported use of anti-hypertensive medication, was 16.9%. However, only 44.8% of those with hypertension were aware of their status, and the overall control rate of hypertension was only 22.4%. Only age and waist circumference were found to be independent predictors of hypertension in the community. CONCLUSION Hypertension was found to be prevalent in the community. However, the respondents' awareness about the problem and the overall control rates were very low. Activities targeted at increasing awareness of hypertension in the community and its risk reduction are very important for intervention. There should also be a national strategy for early detection and treatment of hypertension and related cardiovascular diseases.
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Affiliation(s)
- Feyie Bonsa
- Department of Internal Medicine, Jimma University, Ethiopia
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Kotwani P, Kwarisiima D, Clark TD, Kabami J, Geng EH, Jain V, Chamie G, Petersen ML, Thirumurthy H, Kamya MR, Charlebois ED, Havlir DV. Epidemiology and awareness of hypertension in a rural Ugandan community: a cross-sectional study. BMC Public Health 2013; 13:1151. [PMID: 24321133 PMCID: PMC3890617 DOI: 10.1186/1471-2458-13-1151] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 07/01/2013] [Accepted: 12/05/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hypertension is one of the largest causes of preventable morbidity and mortality worldwide. There are few population-based studies on hypertension epidemiology to guide public health strategies in sub-Saharan Africa. Using a community-based strategy that integrated screening for HIV and non-communicable diseases, we determined the prevalence, awareness, treatment rates, and sociodemographic factors associated with hypertension in rural Uganda. METHODS A household census was performed to enumerate the population in Kakyerere parish in Mbarara district, Uganda. A multi-disease community-based screening campaign for hypertension, diabetes, and HIV was then conducted. During the campaign, all adults received a blood pressure (BP) measurement and completed a survey examining sociodemographic factors. Hypertension was defined as elevated BP (≥ 140/≥ 90 mmHg) on the lowest of three BP measurements or current use of antihypertensives. Prevalence was calculated and standardized to age distribution. Sociodemographic factors associated with hypertension were evaluated using a log-link Poisson regression model with robust standard errors. RESULTS Community participation in the screening campaign was 65%, including 1245 women and 1007 men. The prevalence of hypertension was 14.6%; awareness of diagnosis (38.1%) and current receipt of treatment (20.6%) were both low. Age-standardized to the WHO world standard population, hypertension prevalence was 19.8%, which is comparable to 21.6% in the US and 18.4% in the UK. Sociodemographic factors associated with hypertension included increasing age, male gender, overweight, obesity, diabetes, alcohol consumption, and family history. Prevalence of modifiable factors was high: 28.3% women were overweight/obese and 24.1% men consumed ≥ 10 alcoholic drinks per month. CONCLUSIONS We found a substantial burden of hypertension in rural Uganda. Awareness and treatment of hypertension is low in this region. Enhanced community-based education and prevention efforts tailored to addressing modifiable factors are needed.
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Affiliation(s)
- Prashant Kotwani
- HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, UCSF Box 0874, San Francisco, California 94110, USA
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
| | | | - Tamara D Clark
- HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, UCSF Box 0874, San Francisco, California 94110, USA
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
| | - Jane Kabami
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
| | - Elvin H Geng
- HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, UCSF Box 0874, San Francisco, California 94110, USA
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
| | - Vivek Jain
- HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, UCSF Box 0874, San Francisco, California 94110, USA
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
| | - Gabriel Chamie
- HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, UCSF Box 0874, San Francisco, California 94110, USA
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
| | - Maya L Petersen
- School of Public Health, University of California, Berkeley, California, USA
| | - Harsha Thirumurthy
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Moses R Kamya
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edwin D Charlebois
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Diane V Havlir
- HIV/AIDS Division, Department of Medicine, San Francisco General Hospital, University of California San Francisco, 995 Potrero Avenue, UCSF Box 0874, San Francisco, California 94110, USA
- Makerere University-University of California San Francisco (MU-UCSF) Research Collaboration, Mbarara, Uganda
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van Middendorp D, ten Asbroek A, Bio FY, Edusei A, Meijjer L, Newton S, Agyemang C. Rural and urban differences in blood pressure and pregnancy-induced hypertension among pregnant women in Ghana. Global Health 2013; 9:59. [PMID: 24228792 PMCID: PMC3922859 DOI: 10.1186/1744-8603-9-59] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 05/31/2013] [Accepted: 11/05/2013] [Indexed: 02/03/2023] Open
Abstract
Background Globally, about 350.000 women die every year from pregnancy related causes and more than half of these deaths occur in sub-Saharan Africa (SSA). Approximately 12% of the maternal deaths are associated with hypertensive disorders in pregnancy such as pregnancy induced hypertension (PIH). However, very little is known about PIH and associated determinants in many SSA countries such as Ghana. We therefore sought to assess rural and urban differences in blood pressure (BP) and PIH among pregnant women in Ghana. Methods We conducted a cross-sectional study among 967 rural (677) and urban (290) pregnant women with a gestational age of more than 20 weeks. PIH was defined as a systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg. Results Women in urban Ghana had a higher mean systolic and diastolic BP than women in rural Ghana (105/66 mmHg versus 102/61 mmHg, p < 0.001 for both systolic and diastolic BP). The prevalence of PIH was also higher in urban Ghana (3.1%) than in rural Ghana (0.4%) (p = 0.014). The urban and rural difference in mean diastolic blood pressure persisted even after adjustments for the study characteristics in a linear regression model. In both rural and urban Ghana, BMI, heart rate and a family history of hypertension were independently associated with BP. Conclusion Our findings suggest higher mean BP levels and PIH in urban Ghana than in rural Ghana. BMI was independently related to high BP. Left unchecked, the increasing prevalence of overweight and obesity in Ghana will exacerbate PIH levels in Ghana.
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Affiliation(s)
| | | | | | | | | | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Netherlands PO Box 22660, Amsterdam, The Netherlands.
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Abstract
The epidemic of cardiac risk factors and cardiovascular disease in developing regions has reached sub-Sahara Africa. This global reality needs to energize the academic public health establishment to incorporate this phenomenon in its curriculum. The focus for control of these risk factors and illnesses will need to be on their cultural, political, and economic upstream drivers. The schools of public health will need to collaborate with a broad array of university disciplines to craft a focused and appropriate curriculum with which to train the next generation of global health professionals.
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Kayima J, Wanyenze RK, Katamba A, Leontsini E, Nuwaha F. Hypertension awareness, treatment and control in Africa: a systematic review. BMC Cardiovasc Disord 2013; 13:54. [PMID: 23915151 PMCID: PMC3750220 DOI: 10.1186/1471-2261-13-54] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [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: 04/15/2013] [Accepted: 07/31/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inadequate diagnosis and suboptimal control of hypertension is a major driver of cardiovascular morbidity and mortality in Africa. Understanding the levels of awareness, treatment and control of hypertension and the associated factors has important implications for hypertension control efforts. METHODS The PubMed database was searched for original articles related to awareness, treatment and control of hypertension in Africa published between 1993 and 2013. The key search terms were: Africa, awareness, treatment, control, and hypertension. Exploration of bibliographies cited in the identified articles was done to provide further studies. Full texts of the articles were obtained from various internet sources and individual authors. A data extraction sheet was used to collect this information. RESULTS Thirty-eight studies drawn from 23 African countries from all regions of the continent met the inclusion criteria. The levels of awareness, treatment and control varied widely from country to country. Rural populations had lower levels of awareness than urban areas. North African countries had the highest levels of treatment in the continent. There was generally poor control of hypertension across the region even among subjects that were aware of their status and those that were treated. On the whole, the women had a better control status than the men. CONCLUSION There are low levels of awareness and treatment of hypertension and even lower levels of control. Tailored research is required to uncover specific reasons behind these low levels of awareness and treatment, and especially control, in order to inform policy formulation for the improvement of outcomes of hypertensive patients in Africa.
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Affiliation(s)
- James Kayima
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Achilles Katamba
- Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Elli Leontsini
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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