Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study

A systematic review of pharmaceutical and personal care products as emerging contaminants in waters: The panorama of West Africa

Pharmaceutical and Personal Care Products (PPCPs) are widely used to prevent or treat human and animal diseases, thereby improving the quality of daily life. Poor management of post-consumer products is recognized worldwide, as they negatively affect the ecosystems where they are discharged. The first action to prevent negative impacts is the state of knowledge regarding their occurrence. This paper critically reports the panorama of West Africa in terms of PPCPs occurrence in different water sources. To achieve this objective, a systematic review was conducted on PPCPs in West Africa following the PRISMA guidelines. Databases, including African Journals Online, PubMed, Google Scholar, Scopus, and Dimensions, were used for this search. Thirty-five articles, representing 58 % of West African countries, were selected according to the inclusion and exclusion criteria. Of these articles, one included data from multiple West African countries, while the remaining 34 exclusively focused on Benin, Cameroon, Ghana, and Nigeria. The results revealed a variety of PPCPs investigated, about 27 groups and 112 compounds, with greater emphasis on antibiotics, analgesics and PSHXEs. HPLC was the predominant analytical method used, resulting in total concentrations of PPCPs in the range of 200,000 to 3,200,000 ng/L in drinking water, 12 to 700,000 ng/L in groundwater, 0.42 to 107,800,000 ng/L in surface water, 8.5 to 121,310,000 ng/L in wastewater, and 440 to 421,700 ng/L in tap water. Ghana, Nigeria and Cameroon reported the highest number of PPCPs investigated and consequently the highest concentration of cases. These compounds present a high potential ecological risk, with >50 % exceeding the risk quotient limit. Therefore, West Africa as a community needs integrated approaches and strategies to monitor water, especially transboundary resources. This review is timely and provides pertinent information to policymakers and researchers on PPCPs in water.

Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study

BACKGROUND

Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa.

METHODS

We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies.

RESULTS

The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11-1.77)], complication of hypertension [OR 2.4 (1.89-3.03)], former hypertension [OR 3.12 (2.3-4.26)], good adherence [OR 1.98 (1.47-2.66)], from MIC [OR 1.38 (1.10-1.74)] and living in urban areas [OR 1.52 (1.16-1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC.

CONCLUSION

In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.