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Gafane-Matemane LF, Craig A, Kruger R, Alaofin OS, Ware LJ, Jones ESW, Kengne AP. Hypertension in sub-Saharan Africa: the current profile, recent advances, gaps, and priorities. J Hum Hypertens 2024:10.1038/s41371-024-00913-6. [PMID: 38698111 DOI: 10.1038/s41371-024-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
Recent global and regional reports consistently confirm the high and increasing prevalence of hypertension in sub-Saharan Africa (SSA), with poor detection, treatment, and control rates. This narrative review summarises the burden of hypertension in SSA and recent findings from community-based hypertension management strategies. We further outline prominent risk factors according to recent data and associated underlying mechanisms for hypertension development. An extensive review of literature showed that most countries have reported on the prevalence of hypertension during 2017-2023, despite limitations linked to the lack of nationally representative studies, heterogeneity of sampling and data collection methods. Task-shifting approaches that assign roles to model patients and community health workers reported improved linkage to healthcare services and adherence to medication, with inconsistent findings on blood pressure (BP)-lowering effects over time. The regularly reported risk factors include unhealthy diet, sedentary lifestyle, increased adiposity and underweight, ageing, level of education, and/or income as well as psychosocial factors. Newer data on the pathophysiological mechanisms leading to hypertension and potential areas of intervention are reported from children and adults and include, among others, salt-handling and volume overload, endothelial function, BP dipping patterns and the role of human immunodeficiency virus . To conclude, significant strides have been made in data reporting from SSA on the burden of hypertension in the region as well as biomarker research to improve understanding and identification of areas of intervention. However, gaps remain on linkage between knowledge generation, translation, and implementation research. Coordinated studies addressing both discovery science and public health are crucial to curb hypertension development and improve management in SSA.
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Affiliation(s)
- Lebo F Gafane-Matemane
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa.
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa.
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
- SAMRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | - Omotayo S Alaofin
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520, South Africa
| | - Lisa J Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Soweto, 1864, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University, Mthatha, South Africa
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Okyere J, Ayebeng C, Owusu BA, Dickson KS. Fruits and vegetable consumption, and its association with hypertension among women in Ghana: a cross-sectional study. Public Health Nutr 2023; 27:e19. [PMID: 38148174 PMCID: PMC10830364 DOI: 10.1017/s1368980023002896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE This study aimed to examine the association between fruit and vegetable consumption (FVC) and the risk of hypertension among women in Ghana. DESIGN Data from the 2014 Ghana Demographic and Health Survey were used. Bivariate and multivariate logistic regression analyses were performed using Stata version 14. The study reports the adjusted OR (AOR) and CI. SETTING Ghana. PARTICIPANTS A total sample of 4168 women was used in the analysis. RESULTS Among women who met the WHO's recommended intake of FVC, 13·1 % had hypertension. The intake of the recommended servings of fruit and vegetables was not significantly associated with hypertension. However, the likelihood of being hypertensive was significantly associated with increasing age (AOR = 6·1; 95 % CI = 4·29, 8·73), being married (AOR = 1·7; 95 % CI = 1·14, 2·57) or formerly married (AOR = 2·3; 95 % CI = 1·44, 3·70), and being overweight (AOR = 1·6; 95 % CI = 1·24, 2·07) or obese (AOR = 2·4; 95 % CI = 1·82, 3·20). CONCLUSION The study concludes that there is no significant association between FVC and hypertension risk among women in Ghana. While this study did not find a significant association between FVC and hypertension risk among women in Ghana, it underscores the point that other multifaceted factors influence hypertension risk. As such, public health campaigns should emphasise a balanced and holistic approach to promoting cardiovascular health, including factors beyond FVC. The findings also highlight the need to target high-risk populations (i.e. older women, married and formerly married women, and overweight or obese women) with hypertension prevention education and related interventions.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, University Post Office, PMB, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, University Post Office, PMB, Ghana
| | - Bernard Afriyie Owusu
- Department of Population and Health, University of Cape Coast, Cape Coast, University Post Office, PMB, Ghana
| | - Kwamena Sekyi Dickson
- Department of Population and Health, University of Cape Coast, Cape Coast, University Post Office, PMB, Ghana
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Khonde Kumbu R, Matondo H, Labat A, Kianu B, Godin I, Kiyombo G, Coppieters Y. Job stress, a source of hypertension among workers in Sub-Saharan Africa: a scoping review. BMC Public Health 2023; 23:2316. [PMID: 37993815 PMCID: PMC10666436 DOI: 10.1186/s12889-023-17248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Hypertension remains one of the leading risk factors for cardiovascular disease. Contrasting with the high-income countries where the rates of hypertension decline, it increases in Sub-Saharan African countries. The age group most affected by hypertension is the working population. Several studies carried out in Europe, North America, and Asia, underline the influence of job stress on the occurrence of hypertension. The objective of this review was to explore current knowledge about hypertension and job stress in Sub-Saharan Africa. METHODS We conducted a scoping review using Arksey and O'Malley's framework to synthesize findings. We searched in PubMed, Scopus, and ProQuest databases. The inclusion criteria were peer-reviewed manuscripts published on March 1, 2023, conducted among workers in Sub-Saharan Africa, reported hypertension and job stress, and using quantitative methodologies. Data were assessed independently by two researchers. RESULTS In total, 295 articles were identified from databases. Of these, only 12 articles met the inclusion criteria and were included in the review (9 cross-sectional studies and 3 case-control studies). These studies focused on sectors reported as stressful (health, banking, education, and industries). The prevalence of hypertension varied from 14.3% to 45.9%, with a high proportion of hypertensive participants (35.4%-70.6%) who were unaware that they had hypertension. Job stress was significantly associated with hypertension (OR = 2.4 [1.5-4.4]) and stress management was inversely associated with hypertension (r = -0.14, p < 0.05). However, no study reported an existing workplace health promotion program implemented, especially regarding cardiovascular disease risk factors. CONCLUSION Data available in the literature show that stressful working conditions may be associated with hypertension. We are faced with an increasing prevalence of hypertension among workers in Sub-Saharan Africa, where a large proportion of them are unaware that they have hypertension. Thus, there is a need to implement workplace prevention and health promotion strategies in Sub-Saharan Africa.
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Affiliation(s)
- Rodrigue Khonde Kumbu
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Hervé Matondo
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aline Labat
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Bernard Kianu
- Unit of Cardiology, University Clinic of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Isabelle Godin
- Research Centre in Social Approaches to Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Guillaume Kiyombo
- Environmental Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Yves Coppieters
- Biostatistics and Clinical Research, School of Public Health, Research Centre in Epidemiology, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Byiringiro S, Ogungbe O, Commodore-Mensah Y, Adeleye K, Sarfo FS, Himmelfarb CR. Health systems interventions for hypertension management and associated outcomes in Sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001794. [PMID: 37289741 DOI: 10.1371/journal.pgph.0001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023]
Abstract
Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores the health system interventions on hypertension management and associated outcomes in SSA. The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and October 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for the risk of bias using the tools from the Joanna Briggs Institute. Twelve studies clustered in 8 SSA countries met the inclusion criteria. Two thirds (8/12) of the included studies had low risk of bias. Most interventions focused on health workforce factors such as providers' knowledge and task shifting of hypertension care to unconventional health professionals (n = 10). Other health systems interventions addressed the supply and availability of medical products and technology (n = 5) and health information systems (n = 5); while fewer interventions sought to improve financing (n = 3), service delivery (n = 1), and leadership and governance (n = 1) aspects of the health systems. Health systems interventions showed varied effects on blood pressure outcomes but interventions targeting multiple aspects of health systems were likely associated with improved blood pressure outcomes. The general limitations of the overall body of literature was that studies were likely small, with short duration, and underpowered. In conclusion, the literature on health systems internventions addressing hypertension care are limited in quantity and quality. Future studies that are adequately powered should test the effect of multi-faceted health system interventions on hypertension outcomes with a special focus on financing, leadership and governance, and service delivery interventions since these aspects were least explored.
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Affiliation(s)
- Samuel Byiringiro
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Khadijat Adeleye
- University of Massachusetts, Amherst, MA, United States of America
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ashanti Region, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ashanti Region, Ghana
| | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Rakotondramanana DA, Razafindrakoto ZR, Donno D, Tombozara N, Nalimanana NR, Andrianajara C, Beccaro GL, Ramanitrahasimbola D, Nicoletti M. Bio-guided isolation of androsta-1,4-dien-3,16-dione as a vasodilator active principle from the inflorescence of Ravenala madagascariensis Sonn. (Strelitziaceae). Nat Prod Res 2023; 37:809-818. [PMID: 35724374 DOI: 10.1080/14786419.2022.2089668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Androsta-1,4-dien-3,16-dione was isolated for the first time from the plant kingdom of the ethanolic extract of the Ravenala madagascariensis' inflorescence by the bio-guided method. Its structure was elucidated by NMR and MS spectroscopic data analysis. The vascular effects of ethanol extracts, fractions and androsta-1,4-dien-3,16-dione were assessed on the phenylephrine pre-contracted isolated rat aorta. The isolated compound exerted the most potent vaso-relaxing effect (EC50 = 109.32 ± 15.82 µM) than the ethanol extract and fractions. The pharmacological mechanism of its vaso-relaxing action was analysed on isolated rat aorta using free-endothelial vascular tissue, specific contracting reagents (CaCl2 and KCl), antagonist (propranolol), enzyme inhibitors (L-NAME, methylene blue) and channel blocker (glibenclamide). Its vaso-relaxing activity could be due, at least partly, to the non-specific inhibition of the calcic influx.
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Affiliation(s)
| | | | - Dario Donno
- Dipartimento di Scienze Agrarie, Forestali e Alimentari, Università degli Studi di Torino, Turin, Italy
| | - Nantenaina Tombozara
- Applied Pharmacognosy Laboratory, Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar
| | - Nina Robertina Nalimanana
- Applied Pharmacognosy Laboratory, Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar
| | - Charles Andrianajara
- Applied Pharmacognosy Laboratory, Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar
| | - Gabriele Loris Beccaro
- Dipartimento di Scienze Agrarie, Forestali e Alimentari, Università degli Studi di Torino, Turin, Italy
| | - David Ramanitrahasimbola
- Pharmacy Department, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar.,Applied Pharmacognosy Laboratory, Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar
| | - Marcello Nicoletti
- Department of Environmental Biology, Sapienza University of Roma, Rome, Italy
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Antihypertensive medicine use differs between Ghana and Nigeria. BMC Cardiovasc Disord 2022; 22:368. [PMID: 35948937 PMCID: PMC9364553 DOI: 10.1186/s12872-022-02799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background Non-communicable diseases are a growing burden in many African countries; cardiovascular disease is the main disease. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use in most low- and medium-income countries (LMIC). We aimed to describe the use of antihypertensive medicines (AHM) in Ghana and Nigeria using a novel data source. Methods We used data from mPharma—a health and pharmaceutical company which distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the anatomical therapeutic chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product. Results AHM use differed between Ghana and Nigeria. The most used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria. Conclusion The differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g. standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community.
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7
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Yang Y, Yu D, Piao W, Huang K, Zhao L. Nutrient-Derived Beneficial for Blood Pressure Dietary Pattern Associated with Hypertension Prevention and Control: Based on China Nutrition and Health Surveillance 2015–2017. Nutrients 2022; 14:nu14153108. [PMID: 35956285 PMCID: PMC9370233 DOI: 10.3390/nu14153108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Greater adherence of Dietary Approach to Stop Hypertension (DASH) or the Mediterranean dietary pattern were reported to be beneficial for blood pressure. However, both were established based on Western populations. Our current study aimed to explore a dietary pattern which might be suitable for hypertension prevention and control among Chinese adults nationwide. Methods: A total of 61,747 Chinese adults aged over 18 years from China Nutrition and Health Surveillance 2015–2017 was included in this study. Using reduced-rank regression (RRR) method, a dietary pattern with higher intakes of those nutrients which are inversely associated with the risk of hypertension was identified. DASH-score was also calculated for each participant for further validate the dietary pattern derived by RRR method. Multi-adjustment logistic regression was applied to examine the association between above two dietary patterns and hypertension prevention and control. Results: Dietary pattern named Beneficial for Blood Pressure (BBP) diet was characterized by higher fresh vegetables and fruits, mushrooms/edible fungi, dairy products, seaweeds, fresh eggs, nuts and seeds, legumes and related products, aquatic products, coarse cereals, and less refined grains and alcohol consumption. After multiple adjustment, protective effects showed on both hypertension prevention and control (for prevention: Q5 vs. Q1, OR = 0.842, 95% CI = 0.791–0.896; for control: Q5 vs. Q1, OR = 0.762, 95% CI = 0.629–0.924). For the DASH-diet, significant results were also observed (for prevention: Q5 vs. Q1, OR = 0.912, 95% CI = 0.854–0.973; for control: Q5 vs. Q1, OR = 0.76, 95% CI = 0.616–0.938). Conclusions: BBP-diet derived from Chinese adults has high conformity with the DASH-diet, and it might serve as an adjuvant method for both hypertension prevention and control.
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Abdulwahab M, Kamal M, Akbar A. Screening for High Blood Pressure at the Dentist's Office. Clin Cosmet Investig Dent 2022; 14:79-85. [PMID: 35399622 PMCID: PMC8986194 DOI: 10.2147/ccide.s358890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background High blood pressure is a worldwide issue that can go undetected. Many are unaware of such a problem due to the lack of symptoms in early stages. Visiting the dentist can be a good place to screen for such health issues. Screening dental patients at every dental visit can be of great benefit. The aim of this study was to determine if screening for blood pressure at the dental office is efficient and beneficial for patients. Methods The HEYER VizOR Digital Blood Pressure Monitor was used to measure the blood pressure of all the patients visiting the dental clinic, ranging in age from 18 to 85. The study was comprised of patients who had never been diagnosed as hypertensive by a physician or if they had been diagnosed before. Results A total of 273 participants met the inclusion criteria. One hundred and thirty-seven (50.1%) patients had high blood pressure readings compared to 136 (49.8%) patients with normal blood pressure readings. It also showed that 54 (38%) of patients with high blood pressure readings had never been diagnosed by a physician with hypertension and were unaware of their blood pressure status. In addition, 83 (63.3%) of patients who had been diagnosed with hypertension by a physician had high blood pressure readings. The data also showed that 5.3% of patients diagnosed by their physician do not take their prescribed medication. Conclusion In this study, we showed that screening blood pressure at the dental office can detect high blood pressure readings in dental patients. It is also a useful screening tool for blood pressure for diagnosed and undiagnosed patients. Screening dental patients at the dental office is a useful tool that can help in the screening for blood pressure and should be implemented at every visit.
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Affiliation(s)
- Mohammad Abdulwahab
- Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, Jabryia, Kuwait
| | - Mohammad Kamal
- Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, Jabryia, Kuwait
| | - Ali Akbar
- Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, Jabryia, Kuwait
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Chikafu H, Chimbari M. Hypertension care cascade in the Ingwavuma rural community, uMkhanyakude District, KwaZulu-Natal province of South Africa. PeerJ 2021; 9:e12372. [PMID: 34824908 PMCID: PMC8590801 DOI: 10.7717/peerj.12372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background Treatment and control of hypertension are associated with a substantial reduction in adverse cardiovascular disease outcomes. Although South Africa aims to reduce the burden of cardiovascular diseases, there is limited evidence on the hypertension care cascade (HCC) performance in rural areas where stroke and hypertension are high. This study estimated HCC performance and identified predictors of hypertension screening among adults in the Ingwavuma community of KwaZulu-Natal, South Africa. Methods This was a cross-sectional study. Data were collected using the WHO STEPwise approach to surveillance (STEPS) questionnaire from 400 adult participants, excluding pregnant women and those with physical or cognitive impairments. Three hundred and ninety-three participants had complete data, and 131 had high blood pressure. We calculated progression rates for screening, diagnosis, treatment and control of hypertension from the sub-sample of participants with high blood pressure and assessed the bivariate association between HCC stages and participant characteristics and their effect sizes. We used binary and multivariable logistic regression to identify predictors of hypertension screening. Results Eighty-eight per cent of participants reported prior screening for hypertension. However, only 53.5% of patients under pharmacological treatment for hypertension had controlled blood pressure. In bivariate regression, employed participants were 80.3% (COR = 0.197, 95% CI [0.042–0.921]) more likely to be screened. In multivariable regression, the likelihood of hypertension screening was 82.4% (AOR = 0.176, 95% CI [0.047–0.655]) lower among participants in a cohabiting union than single participants. Similarly, employed participants were 87.4% (AOR = 0.129, 95% CI [0.017–0.952]) less likely to be screened than their unemployed counterparts. Conclusions The considerable attrition from the HCC across socio-demographic categories indicates a need for community-wide interventions. Empowering health care workers for community-based health promotion and hypertension management through point-of-care diagnostic tools could improve HCC performance. Efforts to improve the HCC should also focus on social determinants of health, notably gender and formal educational attainment.
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Affiliation(s)
- Herbert Chikafu
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Moses Chimbari
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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10
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Diendéré EA, Sondo KA, Ouédraogo AR, Dahourou DL, Cissé K, Sawadogo A, Maiga S, Kuiré M, Zida S, Kaboré PR, Minoungou CJW, Habou U, Badalo H, Zoungrana N, Ouédraogo AG, Belem AR, Zoungrana J, Poda A, Diallo I, Kaboré F, Sanou A, Kouanda S. Predictors of severe hypoxemia among COVID-19 patients in Burkina Faso (West Africa): Findings from hospital based cross-sectional study. Int J Infect Dis 2021; 108:289-295. [PMID: 33894354 PMCID: PMC8059284 DOI: 10.1016/j.ijid.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction COVID-19 is one of the world’s major health crises. The objective of this study was to determine the predictive factors of severe hypoxemia in patients hospitalized in COVID-19 health facilities in Burkina Faso. Patients and method This study was a hospital-based cross-sectional study. The data collected relate to the period of the first wave of the epidemic (March 9 to June 30, 2020). All patients hospitalized for COVID-19 in the requisitioned health facilities of Ouagadougou were included in this study. Predictors of severe hypoxemia were identified using a multivariate logistic regression model. Results During the study period, 442 patients were included, representing 45.7% of the total number of positive patients in the entire country. The most common co-morbidities were diabetes (55; 12.4%) and arterial hypertension (97; 21.9%). Severe hypoxemia (SpO2 < 90%) was observed in 64 patients (14.5%). Age over 65 years (OR = 8.24; 95% CI: 2.83–24.01) and diabetes (OR = 2.43; 95% CI: 1.17–5.06) were the predictors for occurrence of severe hypoxemia in multivariate analysis. Conclusion The predictive factors of COVID-19 are similar in African and Caucasian populations. The surveillance of COVID-19 in risk groups should be strengthened to reduce their morbidity and mortality.
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Affiliation(s)
- Eric Arnaud Diendéré
- Internal Medicine Department, Bogodogo Teaching Hospital, Ouagadougou, Burkina Faso.
| | | | | | - Désiré Lucien Dahourou
- Department of Biomedical and Public Health, Research Institute of Health Sciences, Ouagadougou, Burkina Faso.
| | - Kadari Cissé
- Department of Biomedical and Public Health, Research Institute of Health Sciences, Ouagadougou, Burkina Faso.
| | - Abdoulaye Sawadogo
- Infectious Diseases Department, Ouahigouya Teaching Hospital, Ouahigouya, Burkina Faso.
| | - Soumaila Maiga
- Pneumology Department, Ouahigouya Teaching Hospital, Ouahigouya, Burkina Faso.
| | - Marcel Kuiré
- Internal Medicine Department, Pissy District Hospital, Ouagadougou, Burkina Faso.
| | - Seidou Zida
- Internal Medicine Department, Pissy District Hospital, Ouagadougou, Burkina Faso.
| | - Pierre R Kaboré
- Internal Medicine Department, Pissy District Hospital, Ouagadougou, Burkina Faso.
| | | | - Ulrich Habou
- Internal Medicine Department, Bogodogo Teaching Hospital, Ouagadougou, Burkina Faso.
| | - Habil Badalo
- Internal Medicine Department, Bogodogo Teaching Hospital, Ouagadougou, Burkina Faso.
| | - Noelie Zoungrana
- Directorate of Medical and Technical Services, Tengandogo Teaching Hospital, Ouagadougou, Burkina Faso.
| | - Arsène G Ouédraogo
- Infectious Diseases Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso.
| | - Arielle Rita Belem
- Infectious Diseases Department, Souro Sanon Teaching Hospital, Bobo-Dioulasso, Burkina Faso.
| | - Jacques Zoungrana
- Infectious Diseases Department, Souro Sanon Teaching Hospital, Bobo-Dioulasso, Burkina Faso.
| | - Armel Poda
- Infectious Diseases Department, Souro Sanon Teaching Hospital, Bobo-Dioulasso, Burkina Faso.
| | - Ismael Diallo
- Infectious Diseases Department, Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso.
| | - Flavien Kaboré
- Anaesthesia and Resuscitation Department, Tengandogo Teaching Hospital, Ouagadougou, Burkina Faso.
| | - Adama Sanou
- Directorate of Medical and Technical Services, Tengandogo Teaching Hospital, Ouagadougou, Burkina Faso.
| | - Séni Kouanda
- Department of Biomedical and Public Health, Research Institute of Health Sciences, Ouagadougou, Burkina Faso.
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11
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COVID-19 and Vulnerable Populations in Sub-Saharan Africa. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 33656721 DOI: 10.1007/978-3-030-59261-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
The novel corona virus 2019 (COVID-19) outbreak which started in Hubei province in China has now spread to every corner of the earth. While the pandemic started later in Africa, it is now found in all African countries to varying degrees. It is thought that the prevalence and severity of disease is influenced by a number of non-communicable diseases (NCDs) which are all becoming increasingly prevalent in sub-Saharan Africa (SSA). In addition, SSA bears the major burden of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. While data from Europe and the United States show that children are spared severe disease, it is uncertain if the same holds true in SSA where children suffer from sickle cell disease and malnutrition in addition to other infectious diseases. There is limited data from Africa on the effects of these conditions on COVID-19. In this review, we discuss the epidemiology of some of these conditions in Africa and the possible pathogenesis for the interactions of these with COVID-19.
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Stephens JH, Addepalli A, Chaudhuri S, Niyonzima A, Musominali S, Uwamungu JC, Paccione GA. Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda. PLoS One 2021; 16:e0247464. [PMID: 33630935 PMCID: PMC7906377 DOI: 10.1371/journal.pone.0247464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. Objective/Methods We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts. Results/Conclusions Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.
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Affiliation(s)
- Joseph H. Stephens
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
- * E-mail:
| | - Aravind Addepalli
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Shombit Chaudhuri
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Abel Niyonzima
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
| | - Sam Musominali
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
| | - Jean Claude Uwamungu
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Gerald A. Paccione
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
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13
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Ciancio A, Kämpfen F, Kohler HP, Kohler IV. Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa. JOURNAL OF HEALTH ECONOMICS 2021; 75:102388. [PMID: 33249266 PMCID: PMC7855787 DOI: 10.1016/j.jhealeco.2020.102388] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/19/2020] [Accepted: 09/14/2020] [Indexed: 06/01/2023]
Abstract
Evidence for the effectiveness of population health screenings to reduce the burden of non-communicable diseases in low-income countries remains very limited. We investigate the sustained effects of a health screening in Malawi where individuals received a referral letter if they had elevated blood pressure. Using a regression discontinuity design and a matching estimator, we find that receiving a referral letter reduced blood pressure and the probability of being hypertensive by about 22 percentage points four years later. These lasting effects are explained by a 20 percentage points increase in the probability of being diagnosed with hypertension. There is also evidence of an increase in the uptake of medication, while we do not identify improvements in hypertension-related knowledge or risk behaviors. On the contrary, we find an increase in sugar intake and a decrease in physical activity both of which are considered risky behaviors in Western contexts. The health screening had some positive effects on mental health. Overall, this study suggests that population-based hypertension screening interventions are an effective tool to improve health in low-income contexts.
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Affiliation(s)
- Alberto Ciancio
- Department of Economics, HEC, University of Lausanne, Switzerland
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14
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Masenga SK, Sijumbila G. Hypertensive Urgency in Low- and Middle-Income Countries. Am J Hypertens 2020; 33:1084-1086. [PMID: 32812019 DOI: 10.1093/ajh/hpaa132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sepiso K Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Gibson Sijumbila
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
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15
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Okello S, Muhihi A, Mohamed SF, Ameh S, Ochimana C, Oluwasanu AO, Bolarinwa OA, Sewankambo N, Danaei G. Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (SevenCEWA). BMC Public Health 2020; 20:1706. [PMID: 33187491 PMCID: PMC7666461 DOI: 10.1186/s12889-020-09829-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. METHODS Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment. RESULTS We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4%) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of > 30%. CONCLUSION In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.
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Affiliation(s)
- Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, P. O Box 1410, Mbarara, Uganda. .,Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health Systems, Charlottesville, VA, USA.
| | - Alfa Muhihi
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Academy for Public Health, Dar es Salaam, Tanzania.,Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Shukri F Mohamed
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Soter Ameh
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Caleb Ochimana
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Ochimana Caleb Foundation, Federal Capital Territory, Abuja, Nigeria
| | - Abayomi Olabayo Oluwasanu
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,University Health Services, University of Ibadan, Ibadan, Nigeria
| | - Oladimeji Akeem Bolarinwa
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology and Community Health, University of Ilorin, Ilorin, Nigeria
| | - Nelson Sewankambo
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,College of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Goodarz Danaei
- Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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16
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Herskind J, Zelasko J, Bacher K, Holmes D. The outpatient management of hypertension at two Sierra Leonean health centres: A mixed-method investigation of follow-up compliance and patient-reported barriers to care. Afr J Prim Health Care Fam Med 2020; 12:e1-e7. [PMID: 32634014 PMCID: PMC7343919 DOI: 10.4102/phcfm.v12i1.2222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa faces an increasing burden of non-communicable diseases. In particular, hypertension and its therapeutic control present a challenge and opportunity for health practitioners and health systems within the region. AIM This study sought to assess an initiative conducted by two health clinics to begin treatment of hypertension amongst their patient populations by reviewing medication possession rates and documenting patient-reported barriers to care in the provision of chronic hypertension management. SETTING Two private, outpatient health clinics in Sierra Leone recently beginning hypertension management initiatives. METHODS A retrospective chart review identified 487 records of patients with diagnosed hypertension and assessed for medication adherence through calculation of medication possession ratios from pharmacy refill data. Surveys were conducted on a convenience sample of 68 patients of the hypertension treatment programme to discern patient-reported barriers of care. RESULTS Medication possession rates were found to be less than 40% in 82% (399/487) of patients, between 40% and 79% in 12% (60/487) of patients and 80% or greater in 6% (28/487) of patients. In surveys of individuals being treated by the programme, patients were most likely to cite transportation (81%, 55/68), financial burden (69%, 47/68) and schedule conflicts with work or other prior commitments (25%, 17/68) as barriers to care. CONCLUSIONS In this newly instituted outpatient hypertensive management initiative, 82% of patients had medication possession ratios under 40%, which is likely to impact the clinical effectiveness of the initiative. The most frequent patient-reported barriers to care in surveys included transportation, financial burden and schedule conflicts.
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Affiliation(s)
- Jenna Herskind
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
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17
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Stephens JH, Alizadeh F, Bamwine JB, Baganizi M, Chaw GF, Yao Cohen M, Patel A, Schaefle KJ, Mangat JS, Mukiza J, Paccione GA. Managing hypertension in rural Uganda: Realities and strategies 10 years of experience at a district hospital chronic disease clinic. PLoS One 2020; 15:e0234049. [PMID: 32502169 PMCID: PMC7274420 DOI: 10.1371/journal.pone.0234049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
The literature on the global burden of noncommunicable diseases (NCDs) contrasts a spiraling epidemic centered in low-income countries with low levels of awareness, risk factor control, infrastructure, personnel and funding. There are few data-based reports of broad and interconnected strategies to address these challenges where they hit hardest. Kisoro district in Southwest Uganda is rural, remote, over-populated and poor, the majority of its population working as subsistence farmers. This paper describes the 10-year experience of a tri-partite collaboration between Kisoro District Hospital, a New York teaching hospital, and a US-based NGO delivering hypertension services to the district. Using data from patient and pharmacy registers and a random sample of charts reviewed manually, we describe both common and often-overlooked barriers to quality care (clinic overcrowding, drug stockouts, provider shortages, visit non-adherence, and uninformative medical records) and strategies adopted to address these barriers (locally-adapted treatment guidelines, patient-clinic-pharmacy cost sharing, appointment systems, workforce development, patient-provider continuity initiatives, and ongoing data monitoring). We find that: 1) although following CVD risk-based treatment guidelines could safely allocate scarce medications to the highest-risk patients first, national guidelines emphasizing treatment at blood pressures over 140/90 mmHg ignore the reality of "stockouts" and conflict with this goal; 2) often-overlooked barriers to quality care such as poor quality medical records, clinic disorganization and local employment practices are surmountable; 3) cost-sharing initiatives partially fill the gap during stockouts of government supplied medications, but still may be insufficient for the poorest patients; 4) frequent prolonged lapses in care may be the norm for most known hypertensives in rural SSA, and 5) ongoing data monitoring can identify local barriers to quality care and provide the impetus to ameliorate them. We anticipate that our 10-year experience adapting to the complex challenges of hypertension management and a granular description of the solutions we devised will be of benefit to others managing chronic disease in similar rural African communities.
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Affiliation(s)
- Joseph H. Stephens
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
- * E-mail:
| | - Faraz Alizadeh
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
- Boston Medical Center/Boston University, Boston, Massachusetts, United States of America
| | - John Bosco Bamwine
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
| | | | - Gloria Fung Chaw
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Morgen Yao Cohen
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Amit Patel
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - K. J. Schaefle
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Jasdeep Singh Mangat
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
| | - Joel Mukiza
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
| | - Gerald A. Paccione
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Kisoro, Uganda
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
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18
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Blankson PK, Kwamin F, Asibey ABO. Screening at the dental office: An opportunity for bridging the gap in the early diagnosis of hypertension and diabetes in Ghana. Ann Afr Med 2020; 19:40-46. [PMID: 32174614 PMCID: PMC7189880 DOI: 10.4103/aam.aam_22_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: The prevalence of hypertension and diabetes is increasing in Ghana and sub-Saharan Africa. Screening is a useful tool in improving the early detection of both diseases to reduce the mortality and morbidity associated with the conditions. This study set out to determine the prevalence of patients with hypertension and hyperglycemia attending a dental clinic in Accra. Methods: A cross-sectional study, modeling a screening exercise, was conducted in a major dental clinic in Accra. Hypertension and diabetes were screened for with serial blood pressure checks at rest and random blood glucose measurements, respectively. Other variables were the pulse rate, the respiratory rate, and the background characteristics of respondents. Data were analyzed with Stata Version 14, and descriptive statistics were generated and reported. Results: There were a total of 175 participants in the study, comprising 76 males (43.4%) and 99 females (56.6%). This represented a male-to-female ratio of 0.8:1. The ages ranged from 18 to 86 years, with the median and mean ages of 40 years and 43.1 years (±16.9), respectively. This study found the prevalence of hypertension and hyperglycemia in the dental clinic to be 31.4% and 24.6%, respectively. Conclusion: The results of this study demonstrate the importance of the dental clinic in detecting both undiagnosed hypertension and diabetes, as well as those who have previously been diagnosed, but do not have their blood pressure and blood sugar under adequate control. With efficient referrals and follow-up systems in place at dental offices, they could be harnessed as a fertile place for hypertension and diabetes screening.
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Affiliation(s)
- Paa-Kwesi Blankson
- Department of Oral and Maxillofacial Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Francis Kwamin
- Department of Oral Pathology and Medicine, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| | - Aaron B Osei Asibey
- Department of Oral Pathology and Medicine, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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19
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Heart Failure among People with HIV: Evolving Risks, Mechanisms, and Preventive Considerations. Curr HIV/AIDS Rep 2020; 16:371-380. [PMID: 31482297 DOI: 10.1007/s11904-019-00458-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE People with HIV (PHIV) with access to modern antiretroviral therapy (ART) face a two-fold increased risk of heart failure as compared with non-HIV-infected individuals. The purpose of this review is to consider evolving risks, mechanisms, and preventive considerations pertaining to heart failure among PHIV. RECENT FINDINGS While unchecked HIV/AIDS has been documented to precipitate heart failure characterized by overtly reduced cardiac contractile function, ART-treated HIV may be associated with either heart failure with reduced ejection fraction (HFrEF) or with heart failure with preserved ejection fraction (HFpEF). In HFpEF, a "stiff" left ventricle cannot adequately relax in diastole-a condition known as diastolic dysfunction. Diastolic dysfunction, in turn, may result from processes including myocardial fibrosis (triggered by hypertension and/or immune activation/inflammation) and/or myocardial steatosis (triggered by metabolic dysregulation). Notably, hypertension, systemic immune activation, and metabolic dysregulation are all common conditions among even those PHIV who are well-treated with ART. Of clinical consequence, HFpEF is uniquely intransigent to conventional medical therapies and portends high morbidity and mortality. However, diastolic dysfunction is reversible-as are contributing processes of myocardial fibrosis and myocardial steatosis. Our challenges in preserving myocardial health among PHIV are two-fold. First, we must continue working to realize UNAIDS 90-90-90 goals. This achievement will reduce AIDS-related mortality, including cardiovascular deaths from AIDS-associated heart failure. Second, we must work to elucidate the detailed mechanisms continuing to predispose ART-treated PHIV to heart failure and particularly HFpEF. Such efforts will enable the development and implementation of targeted preventive strategies.
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Manafe N, Matimbe RN, Daniel J, Lecour S, Sliwa K, Mocumbi AO. Hypertension in a resource-limited setting: Poor Outcomes on Short-term Follow-up in an Urban Hospital in Maputo, Mozambique. J Clin Hypertens (Greenwich) 2019; 21:1831-1840. [PMID: 31769184 PMCID: PMC8030297 DOI: 10.1111/jch.13732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Abstract
Mozambique has low levels of detection, treatment, and control of hypertension. However, data on target organ damage and clinical outcomes are lacking. The authors aimed at characterizing the clinical profile, pattern of target organ damage, and short-term outcomes of patients referred to a first referral urban hospital in a low-income setting in Africa. We conducted a prospective descriptive cohort study from February 2016 to May 2017 in Maputo, Mozambique. Adult patients with systolic and diastolic blood pressure ≥180 mm Hg and/or ≥110 mm Hg, respectively, or any systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg in the presence of target organ damage (with or without antihypertensive treatment) were submitted to detailed physical examination, funduscopy, laboratory profile, electrocardiography, and echocardiography. Six months after the occurrence of complications (stroke, heart failure, and renal failure), hospital admission and death were assessed. Overall, 116 hypertensive patients were recruited (mean age 57.5 ± 12.8 years old; 111[95.7%] black; 81[70%] female) of which 79 had severe hypertension. The baseline mean values recorded for systolic and diastolic blood pressure were 192.3 ± 23.6 and 104.2 ± 15.2 mm Hg, respectively. Most patients (93; 80.2%) were on antihypertensive treatment. Patients' risk profile revealed dyslipidemia, obesity, and diabetes in 59(54.1%), 48(42.5%), and 23(19.8%), respectively. Target organ damage was found in 111 patients. The commonest being left atrial enlargement 91(84.5%), left ventricular hypertrophy 57(50.4%), hypertensive retinopathy 30(26.3%), and chronic kidney disease 27(23.3%). Major events during 6-month follow-up were hospitalizations in 10.3% and death in 8.6% of the patients. Worsening of target organ damage occurred in 10 patients: four stroke, two heart failure, and four renal damage. Patients with severe hypertension and target organ damage were young with high-risk profile, low hypertension control, and high occurrence of complications during short-term follow-up. Efforts to improve high blood pressure control are needed to reduce premature mortality in this highly endemic poor setting.
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Affiliation(s)
- Naisa Manafe
- Instituto Nacional de SaudeMaputoMozambique
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | | | | | - Sandrine Lecour
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Karen Sliwa
- Department of Medicine and CardiologyFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Ana Olga Mocumbi
- Instituto Nacional de SaudeMaputoMozambique
- Universidade Eduardo MondlaneMaputoMozambique
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Gaye B, Diop M, Narayanan K, Offredo L, Reese P, Antignac M, Diop V, Mbacké AB, Boyer Chatenet L, Marijon E, Singh-Manoux A, Diop IB, Jouven X. Epidemiological transition in morbidity: 10-year data from emergency consultations in Dakar, Senegal. BMJ Glob Health 2019; 4:e001396. [PMID: 31406585 PMCID: PMC6666800 DOI: 10.1136/bmjgh-2019-001396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/29/2019] [Accepted: 05/25/2019] [Indexed: 01/30/2023] Open
Abstract
Background It is thought that low-income countries are undergoing an epidemiological transition from infectious to non-communicable diseases; however, this phenomenon is yet to be examined with long-term data on morbidity. Methods We performed a prospective evaluation of all emergency medical consultations at a major emergency service provider in Dakar, Senegal from 2005 to 2014. Using standardised definitions, the primary diagnosis for each consultation was classified using the International Classification of Diseases-10 and then broadly categorised as ‘infectious’, ‘non-communicable’ and ‘other’ diseases. Morbidity rates for each year in the 10-year observation period were plotted to depict the epidemiological transition over time. To quantify the yearly rate ratios of non-communicable over infectious diagnosis, we used a generalised Poisson mixed model. Results Complete data were obtained from 49 702 visits by African patients. The mean age was 36.5±23.2 and 34.8±24.3 years for women and men, respectively. Overall, infections accounted for 46.3% and 42.9% and non-communicable conditions 32.2% and 40.1% of consultations in women and men, respectively. Consultation for non-communicable compared with infectious conditions increased by 7% every year (95% CI: 5% to 9%; p<0.0001) over the 10 years. Consultations for non-communicable condition were more likely in women compared with men (RR=1.29, 95% CI: 1.18, 1.40) and at older ages (RR=1.27; 95% CI 1.25, 1.29 for 10-year increase in age). Conclusion Using high-quality disease morbidity data over a decade, we provide novel data showing the epidemiological transition of diseases as manifested in emergency service consultations in a large Sub-Saharan African city. These results can help reorientation of healthcare policy in Sub-Saharan Africa.
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Affiliation(s)
- Bamba Gaye
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France.,Cardiology Department, Georges-Pompidou European Hospital, 56, rue Leblanc, Paris, France.,UFR des Technologies et des Métiers, Université Cheikh Ahmadoul Khadim (UCAK) de Touba, Diourbel, Senegal
| | | | | | - Lucile Offredo
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
| | - Peter Reese
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marie Antignac
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
| | | | - Ahmadoul Badaviyou Mbacké
- UFR des Technologies et des Métiers, Université Cheikh Ahmadoul Khadim (UCAK) de Touba, Diourbel, Senegal
| | | | - Eloi Marijon
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France.,Cardiology Department, Georges-Pompidou European Hospital, 56, rue Leblanc, Paris, France
| | - Archana Singh-Manoux
- INSERM, U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université Paris-Descartes, Paris, France
| | | | - Xavier Jouven
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France.,Cardiology Department, Georges-Pompidou European Hospital, 56, rue Leblanc, Paris, France
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22
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Lunyera J, Kirenga B, Stanifer JW, Kasozi S, van der Molen T, Katagira W, Kamya MR, Kalyesubula R. Geographic differences in the prevalence of hypertension in Uganda: Results of a national epidemiological study. PLoS One 2018; 13:e0201001. [PMID: 30067823 PMCID: PMC6070243 DOI: 10.1371/journal.pone.0201001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 07/07/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertension accounts for more than 212 million global disability-adjusted life-years, and more than 15 million in sub-Saharan Africa. Identifying factors underlying the escalating burden of hypertension in sub-Saharan Africa may inform delivery of targeted public health interventions. METHODS As part of the cross-sectional nationally representative Uganda National Asthma Survey conducted in 2016, we measured blood pressure (BP) in the general population across five regions of Uganda. We defined hypertension as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, or on-going use of medications for the purpose of lowering BP among adults (≥18 years of age); pre-hypertension as systolic BP between 120 and 140 mmHg and/or diastolic BP bteween 80 and 90 mmHg among adolescents and adults (≥12 years of age). FINDINGS Of 3416 participants who met inclusion criteria, 38.9% were male, and mean age ± SD was 33.8 ± 16.9 years. The age- and sex-adjusted prevalence of hypertension was 31.5% (95% confidence interval [CI] 30.2 to 32.8). The adjusted prevalence of hypertension was highest in the Central Region (34.3%; 95% CI 32.6 to 36.0), and it was comparable to that in the West and East Regions. However, compared with the Central Region, hypertension was significantly less prevalent in the North (22.0%; 95 CI 19.4 to 24.6) and West Nile Regions (24.1%; 95% CI 22.0 to 26.3). Adjustment for demographic characteristics (occupation, monthly income, and educational attainment) of participants did not account for the significantly lower prevalence of hypertension in the North and West Nile Regions. The prevalence of pre-hypertension was 38.8% (95% CI 37.7 to 39.8), and it was highly prevalent among young adults (21-40 years of age: 42.8%; 95% CI 41.2-44.5%) in all regions. CONCLUSIONS Hypertension is starkly prevalent in Uganda, and numerous more people, including young adults are at increased risk. The burden of hypertension is highest in the Central, Western, and Eastern regions of the country; demographic characteristics did not fully account for the disparate regional burden of hypertension. Future studies should explore the potential additional impact of epidemiological shifts, including diet and lifestyle changes, on the development of hypertension.
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Affiliation(s)
- Joseph Lunyera
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States of America
- * E-mail:
| | - Bruce Kirenga
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - John W. Stanifer
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | - Thys van der Molen
- Department of General Practice and Elderly Care, and Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), The Netherlands
| | | | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
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23
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Brody AM, Kumar VA, Levy PD. Hot Topic: Global Burden of Treating Hypertension-What is the Role of the Emergency Department? Curr Hypertens Rep 2018; 19:8. [PMID: 28176250 DOI: 10.1007/s11906-017-0707-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hypertension (HTN) is the most common modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality worldwide. Lower- and middle-income countries (LMICs) are projected to bear the vast majority of this disease burden, but local and regional health care delivery systems in these countries are ill equipped to meet this need. Emergency care is receiving increased recognition as a crucial component of public and community health. The rapid evolution of emergency care in LMICs provides a unique opportunity to develop innovative strategies, incorporating existing strengths of emergency departments, to address this paradigm shift in the disease burden associated with HTN on a global scale.
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Affiliation(s)
- Aaron M Brody
- Wayne State University School of Medicine, Detroit, MI, 48201, USA.
| | - Vijaya A Kumar
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48104, USA
| | - Phillip D Levy
- Department of Emergency Medicine and Cardiovascular Research Institute, Integrated Biosciences Center, Wayne State University School of Medicine, 6135 Woodward Ave, Detroit, MI, 48202, USA
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24
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Katalambula LK, Meyer DN, Ngoma T, Buza J, Mpolya E, Mtumwa AH, Petrucka P. Dietary pattern and other lifestyle factors as potential contributors to hypertension prevalence in Arusha City, Tanzania: a population-based descriptive study. BMC Public Health 2017; 17:659. [PMID: 28814286 PMCID: PMC5559771 DOI: 10.1186/s12889-017-4679-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High blood pressure is increasing worldwide, disproportionately so in developing countries. Inadequate health care systems and adoption of unhealthy lifestyles have been linked to this emergent pattern. To better understand this trend, it is imperative we measure prevalence of hypertension, and examine specific risk factors, at a local level. This study provides a cross-sectional view of urban residents of Arusha City to determine prevalence and associated risk factors. METHODS Blood pressure was measured using a digital sphygmomanometer. Interviews were conducted using the WHO STEPwise survey questionnaire to assess lifestyle factors. Dietary intake information was collected by a standardized Food Frequency Questionnaire (FFQ). Descriptive statistics were used to analyze demographic characteristics. Means and standard deviations were calculated for continuous variables and percentages for categorical variables. Pearson's Chi Square (χ 2) tests were used to determine significant risk factors for hypertension, and multivariate log binomial regression was used to reveal potential predictors of hypertension. Dietary patterns were analyzed by principal component analysis. RESULTS Approximately 45% of the study population was found to be hypertensive. The mean arterial blood pressure (MABP) of the sample was 102.3 mmHg (SD = 18.3). Mean systolic and diastolic blood pressure were 136.3 (SD = 30.5) and 85.3 (SD = 16.1) mmHg, respectively. Through multivariate analysis, age and body mass index were found to be independently, positively, associated with hypertension. Adherence to 'healthy' dietary pattern was negatively independently associated with hypertension. CONCLUSIONS With nearly half of participants being hypertensive, this study suggests that hypertension is a significant health risk in Arusha, Tanzania. Obesity, healthy diet, and age were found to be positively associated with hypertension risk. This study did not establish any significant association between increased blood pressure and Western-dietary pattern, cigarette smoking, alcohol intake, and physical activities.
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Affiliation(s)
- L. K. Katalambula
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology Department of Public Health, University of Dodoma, Dodoma, Tanzania
| | - D. N. Meyer
- School of Public Health, University of Saskatchewan, Saskatoon, SK Canada
| | - T. Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - J. Buza
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - E. Mpolya
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - A. H. Mtumwa
- Department of Statistics, University of Dodoma, Dodoma, Tanzania
| | - P. Petrucka
- College of Nursing, University of Saskatchewan, Regina, SK Canada
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25
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Nichols M, Sarfo FS, Singh A, Qanungo S, Treiber F, Ovbiagele B, Saulson R, Patel S, Jenkins C. Assessing Mobile Health Capacity and Task Shifting Strategies to Improve Hypertension Among Ghanaian Stroke Survivors. Am J Med Sci 2017; 354:573-580. [PMID: 29208254 DOI: 10.1016/j.amjms.2017.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND There has been a tremendous surge in stroke prevalence in sub-Saharan Africa. Hypertension (HTN), the most potent, modifiable risk factor for stroke, is a particular challenge in sub-Saharan Africa. Culturally sensitive, efficacious HTN control programs that are timely and sustainable are needed, especially among stroke survivors. Mobile health (mHealth) technology and task-shifting offer promising approaches to address this need. METHODS Using a concurrent triangulation design, we collected data from stroke survivors, caregivers, community leaders, clinicians and hospital personnel to explore the barriers, facilitators and perceptions toward mHealth related to HTN management among poststroke survivors in Ghana. Exploration included perceptions of a nurse-led navigational model to facilitate care delivery and willingness of stroke survivors and caregivers to use mHealth technology. RESULTS Two hundred stroke survivors completed study surveys while focus groups (n = 4) were conducted with stroke survivors, caregivers and community leaders (n = 28). Key informant interviews were completed with clinicians and hospital personnel (n = 10). A total of 93% of survey respondents had HTN (60% uncontrolled). Findings support mHealth strategies for poststroke care delivery and HTN management and for task-shifting through a nurse-led model. Of survey and focus group participants, 76% and 78.6%, respectively, have access to mobile phones and 90% express comfort in using mobile phones and conveyed assurance that task-shifting through a nurse-led model could facilitate management of HTN. Findings also identified barriers to care delivery and medication adherence across all levels of the social ecological model. CONCLUSIONS Participants strongly supported enhanced care delivery through mobile health and were receptive toward a nurse-led navigational model.
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Affiliation(s)
- Michelle Nichols
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina.
| | - Fred Stephen Sarfo
- Department of Medicine, Neurology Unit, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Arti Singh
- KNUST Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Suparna Qanungo
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina
| | - Frank Treiber
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Raelle Saulson
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Sachin Patel
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina
| | - Carolyn Jenkins
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina
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26
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Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Mol PGM. Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ Open 2017; 7:e015743. [PMID: 28775184 PMCID: PMC5724212 DOI: 10.1136/bmjopen-2016-015743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/09/2017] [Accepted: 06/28/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES We examined determinants of achieving blood pressure control in patients with hypertension and of treatment intensification in patients with uncontrolled blood pressure (BP). DESIGN A retrospective cohort study in six public hospitals, Ethiopia. PARTICIPANTS Adult ambulatory patients with hypertension and with at least one previously prescribed antihypertensive medication in the study hospital. OUTCOME Controlled BP (<140/90 mm Hg) and treatment intensification of patients with uncontrolled BP. RESULTS The study population comprised 897 patients. Their mean age was 57 (SD 14) years, 63% were females, and 35% had one or more cardiometabolic comorbidities mainly diabetes mellitus. BP was controlled in 37% of patients. Treatment was intensified for 23% patients with uncontrolled BP. In multivariable (logistic regression) analysis, determinants positively associated with controlled BP were treatment at general hospitals (OR 1.89, 95% CI 1.26 to 2.83) compared with specialised hospitals and longer treatment duration (OR 1.04, 95% CI 1.01 to 1.06). Negatively associated determinants were previously uncontrolled BP (OR 0.30, 95% CI 0.21 to 0.43), treatment regimens with diuretics (OR 0.68, 95% CI 0.50 to 0.94) and age (OR 0.99, 95% CI 0.98 to 1.00). The only significant-positive-determinant for treatment intensification was duration of therapy (OR 1.05, 95% CI 1.02 to 1.09). CONCLUSIONS The level of controlled BP and treatment intensification practice in this study was low. The findings suggest the need for in-depth understanding and interventions of the identified determinants such as uncontrolled BP on consecutive visits, older age and type of hospital.
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Affiliation(s)
- Derbew Fikadu Berhe
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pharmacy, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Katja Taxis
- Department of Pharmacy, Unit Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| | - Flora M Haaijer-Ruskamp
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Afework Mulugeta
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Yewondwossen Tadesse Mengistu
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Peter G M Mol
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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27
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Kuate Defo B, Mbanya JC, Tardif JC, Ekundayo O, Perreault S, Potvin L, Cote R, Kengne AP, Choukem SP, Assah F, Kingue S, Richard L, Pongou R, Frohlich K, Saji J, Fournier P, Sobngwi E, Ridde V, Dubé MP, De Denus S, Mbacham W, Lafrance JP, Nsagha DS, Mampuya W, Dzudie A, Cloutier L, Zarowsky C, Tanya A, Ndom P, Hatem M, Rey E, Roy L, Borgès Da Silva R, Dagenais C, Todem D, Weladji R, Mbanya D, Emami E, Njoumemi Z, Monnais L, Dubois CA. Diagnosis, Prevalence, Awareness, Treatment, Prevention, and Control of Hypertension in Cameroon: Protocol for a Systematic Review and Meta-Analysis of Clinic-Based and Community-Based Studies. JMIR Res Protoc 2017; 6:e102. [PMID: 28554882 PMCID: PMC5468543 DOI: 10.2196/resprot.7807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 12/27/2022] Open
Abstract
Background Hypertension holds a unique place in population health and health care because it is the leading cause of cardiovascular disease and the most common noncommunicable condition seen in primary care worldwide. Without effective prevention and control, raised blood pressure significantly increases the risk of stroke, myocardial infarction, chronic kidney disease, heart failure, dementia, renal failure, and blindness. There is an urgent need for stakeholders—including individuals and families—across the health system, researchers, and decision makers to work collaboratively for improving prevention, screening and detection, diagnosis and evaluation, awareness, treatment and medication adherence, management, and control for people with or at high risk for hypertension. Meeting this need will help reduce the burden of hypertension-related disease, prevent complications, and reduce the need for hospitalization, costly interventions, and premature deaths. Objective This review aims to synthesize evidence on the epidemiological landscape and control of hypertension in Cameroon, and to identify elements that could potentially inform interventions to combat hypertension in this setting and elsewhere in sub-Saharan Africa. Methods The full search process will involve several steps, including selecting relevant databases, keywords, and Medical Subject Headings (MeSH); searching for relevant studies from the selected databases; searching OpenGrey and the Grey Literature Report for gray literature; hand searching in Google Scholar; and soliciting missed publications (if any) from relevant authors. We will select qualitative, quantitative, or mixed-methods studies with data on the epidemiology and control of hypertension in Cameroon. We will include published literature in French or English from electronic databases up to December 31, 2016, and involving adults aged 18 years or older. Both facility and population-based studies on hypertension will be included. Two reviewers of the team will independently search, screen, extract data, and assess the quality of selected studies using suitable tools. Selected studies will be analyzed by narrative synthesis, meta-analysis, or both, depending on the nature of the data retrieved in line with the review objectives. Results This review is part of an ongoing research program on disease prevention and control in the context of the dual burden of communicable and noncommunicable diseases in Africa. The first results are expected in 2017. Conclusions This review will provide a comprehensive assessment of the burden of hypertension and control measures that have been designed and implemented in Cameroon. Findings will form the knowledge base relevant to stakeholders across the health system and researchers who are involved in hypertension prevention and control in the community and clinic settings in Cameroon, as a yardstick for similar African countries. Trial Registration PROSPERO registration number: CRD42017054950; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42017054950 (Archived by WebCite at http://www.webcitation.org/6qYSjt9Jc)
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Affiliation(s)
- Barthelemy Kuate Defo
- Department of Social and Preventive Medicine, Department of Demography and Public Health Research Institute, Université de Montréal, Montreal, QC, Canada
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | - Olugbemiga Ekundayo
- Department of Public Health and Health Administration, College of Health Science and Public Health, Eastern Washington University, Spokane, WA, United States
| | - Sylvie Perreault
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada
| | - Louise Potvin
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Robert Cote
- Departments of Neurology, Neurosurgery and Medicine, McGill University, Montreal, QC, Canada
| | | | - Simeon Pierre Choukem
- Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Felix Assah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Samuel Kingue
- Department of Cardiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Lucie Richard
- Faculté des sciences infirmières, Université de Montréal, Montreal, QC, Canada
| | - Roland Pongou
- Department of Economics, University of Ottawa, Ottawa, ON, Canada
| | - Katherine Frohlich
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jude Saji
- Public Health Research Institute, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Pierre Fournier
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Eugene Sobngwi
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Valery Ridde
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Simon De Denus
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Wilfred Mbacham
- Department of Biochemistry and Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Jean-Philippe Lafrance
- Faculté de médecine et Faculté de pharmacologie, Université de Montréal, Montreal, QC, Canada
| | - Dickson Shey Nsagha
- Department of Public Health Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Warner Mampuya
- Faculté de Médecine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anastase Dzudie
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Lyne Cloutier
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Agatha Tanya
- College of Technology, University of Bamenda, Bamenda, Cameroon
| | - Paul Ndom
- Department of Oncology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Marie Hatem
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - Evelyne Rey
- Faculty of Medicine and CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Louise Roy
- Service de néphrologie (CHUM-Saint-Luc) & Faculté de médecine, Université de Montréal, Montreal, QC, Canada
| | | | - Christian Dagenais
- Département de psychologie, Université de Montréal, Montreal, QC, Canada
| | - David Todem
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, United States
| | - Robert Weladji
- Department of Biology, Concordia University, Montreal, QC, Canada
| | - Dora Mbanya
- Department of Haematology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Elham Emami
- Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Zakariaou Njoumemi
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Laurence Monnais
- Département d'histoire, Université de Montréal, Montreal, QC, Canada
| | - Carl-Ardy Dubois
- Faculté des sciences infirmières, Université de Montréal, Montreal, QC, Canada
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28
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Gómez-Olivé FX, Ali SA, Made F, Kyobutungi C, Nonterah E, Micklesfield L, Alberts M, Boua R, Hazelhurst S, Debpuur C, Mashinya F, Dikotope S, Sorgho H, Cook I, Muthuri S, Soo C, Mukomana F, Agongo G, Wandabwa C, Afolabi S, Oduro A, Tinto H, Wagner RG, Haregu T, Wade A, Kahn K, Norris SA, Crowther NJ, Tollman S, Sankoh O, Ramsay M. Regional and Sex Differences in the Prevalence and Awareness of Hypertension: An H3Africa AWI-Gen Study Across 6 Sites in Sub-Saharan Africa. Glob Heart 2017; 12:81-90. [PMID: 28302553 DOI: 10.1016/j.gheart.2017.01.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is a high prevalence of hypertension and related cardiovascular diseases in sub-Saharan Africa, yet few large studies exploring hypertension in Africa are available. The actual burden of disease is poorly understood and awareness and treatment to control it is often suboptimal. OBJECTIVES The study sought to report the prevalence of measured hypertension and to assess awareness and control of blood pressure among older adults in rural and urban settings in 6 sites located in West, East, and Southern Africa. In addition, we examined regional, sex, and age differences related to hypertension. METHODS A population-based cross-sectional study was performed at 6 sites in 4 African countries: Burkina Faso (Nanoro), Ghana (Navrongo), Kenya (Nairobi), and South Africa (Agincourt, Dikgale, Soweto). Blood pressure measurements were taken using standardized procedures on 10,696 adults 40 to 60 years of age. Hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or taking antihypertensive medication. RESULTS The mean prevalence of hypertension ranged from 15.1% in Nanoro to 54.1% in Soweto. All 3 of the South African sites had a mean prevalence of hypertension of over 40.0%, significantly higher than in Nairobi (25.6%) and Navrongo (24.5%). Prevalence increased with age in both sexes and at all sites. A significantly higher prevalence of hypertension was observed in women in Agincourt, Dikgale, and Nairobi, whereas in Nanoro this trend was reversed. Within the hypertensive group the average proportion of participants who were aware of their blood pressure status was only 39.4% for men and 53.8% for women, and varied widely across sites. CONCLUSIONS Our study demonstrates that the prevalence of hypertension and the level of disease awareness differ not only between but also within sub-Saharan African countries. Each nation must tailor their regional hypertension awareness and screening programs to match the characteristics of their local populations.
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Affiliation(s)
- F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Stuart A Ali
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Made
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Lisa Micklesfield
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marianne Alberts
- Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Romuald Boua
- Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Scott Hazelhurst
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Electrical & Information Engineering, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Felistas Mashinya
- Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Sekgothe Dikotope
- Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Hermann Sorgho
- Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Ian Cook
- Physical Activity Epidemiology Laboratory (EDST), School of Education, Faculty of Humanities, University of Limpopo, Polokwane, South Africa
| | - Stella Muthuri
- African Population and Health Research Center, Nairobi, Kenya
| | - Cassandra Soo
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Freedom Mukomana
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sulaimon Afolabi
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Halidou Tinto
- Institut de Recherche en Sciences de la Sante, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tilahun Haregu
- African Population and Health Research Center, Nairobi, Kenya
| | - Alisha Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Osman Sankoh
- INDEPTH Network, Accra, Ghana; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Mathematics and Statistics, Njala University, Njala, Sierra Leone
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Nulu S. Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor. Glob Public Health 2016; 12:396-415. [PMID: 26948138 DOI: 10.1080/17441692.2016.1154584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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