Remote Ischaemic Conditioning in STEMI Patients in Sub-Saharan AFRICA: Rationale and Study Design for the RIC-AFRICA Trial

Abstract Purpose Despite evidence of myocardial infarct size reduction in animal studies, remote ischaemic conditioning (RIC) failed to improve clinical outcomes in the large CONDI-2/ERIC-PPCI trial. Potential reasons include that the predominantly low-risk study participants all received timely optimal reperfusion therapy by primary percutaneous coronary intervention (PPCI). Whether RIC can improve clinical outcomes in higher-risk STEMI patients in environments with poor access to early reperfusion or PPCI will be investigated in the RIC-AFRICA trial. Methods The RIC-AFRICA study is a sub-Saharan African multi-centre, randomized, double-blind, sham-controlled clinical trial designed to test the impact of RIC on the composite endpoint of 30-day mortality and heart failure in 1200 adult STEMI patients without access to PPCI. Randomized participants will be stratified by whether or not they receive thrombolytic therapy within 12 h or arrive outside the thrombolytic window (12–24 h). Participants will receive either RIC (four 5-min cycles of inflation [20 mmHg above systolic blood pressure] and deflation of an automated blood pressure cuff placed on the upper arm) or sham control (similar protocol but with low-pressure inflation of 20 mmHg and deflation) within 1 h of thrombolysis and applied daily for the next 2 days. STEMI patients arriving greater than 24 h after chest pain but within 72 h will be recruited to participate in a concurrently running independent observational arm. Conclusion The RIC-AFRICA trial will determine whether RIC can reduce rates of death and heart failure in higher-risk sub-optimally reperfused STEMI patients, thereby providing a low-cost, non-invasive therapy for improving health outcomes.

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Abstract P359: High Blood Pressure in African HIV+ Patients Increases Long-Term Mortality

Circulation ◽

10.1161/circ.129.suppl_1.p359 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Gerald S Bloomfield ◽

Joseph W Hogan ◽

Alfred Keter ◽

Thomas L Holland ◽

Edwin Sang ◽

...

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Regression Models ◽

Proportional Hazards ◽

Mortality Rates ◽

Sub Saharan Africa ◽

Proportional Hazards Regression ◽

Crude Mortality ◽

Sub Saharan ◽

The Impact

Background: Patients with human immunodeficiency virus (HIV) in the modern era are at risk of developing cardiovascular diseases. High blood pressure (BP) is common in sub-Saharan Africa, however, global attention in the region has been mostly focused on HIV. The impact of BP on mortality among adults with HIV in this region has not been reported. Objective: The objective was to determine the impact of BP on mortality among HIV seropositive (+) adults without acquired immune deficiency syndrome (AIDS) in Kenya. Methods: We conducted a retrospective analysis of de-identified medical records of the Academic Model Providing Access to Healthcare HIV treatment program between 2005 and 2010. We excluded patients with AIDS, who were <16 or >80 years old, or with data out of acceptable ranges. There were 49,475 HIV+ individuals who satisfied inclusion/exclusion criteria (Figure 1). Missing data for key covariates was addressed by inverse probability weighting. We summarize crude mortality rates across BP categories, separately by gender. We used proportional hazards regression models to characterize the effect of BP on mortality, adjusting for baseline demographic and clinical factors. We subdivided the sample according to those who were clinically stable, defined as having ≥CD4 350 or WHO Stage 1. Results: Our sample was 74% (36,616 of 49,475) women. Mortality rates for men and women were 3.8/100 and 1.8/100 person-years, respectively. Crude mortality rate among clinically stable men was higher with systolic BP ≥140 mmHg (3.0, 95% CI: 1.6-5.5) than with normal systolic BP (1.1, 95% CI: 0.7-1.7). In weighted proportional hazards regression models, clinically stable men with systolic BP ≥140 mmHg carried a higher mortality risk than normotensive men (HR: 2.39, 95% CI: 0.94 to 6.08). Conclusions: Blood pressure is an important aspect of the care of HIV+ patients in sub-Saharan Africa. High systolic BP is associated with mortality among clinically stable men without AIDS. Further investigation into cause of death in warranted.

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Conflicts in Biafra, Katanga and Cabinda as a result of the geopolitical legacy of colonialism

OOO Zhurnal Voprosy Istorii ◽

10.31166/voprosyistorii202010statyi60 ◽

2020 ◽

Vol 2020 (10-3) ◽

pp. 238-246

Author(s):

Olga Dzhenchakova

Keyword(s):

Democratic Republic ◽

Economic Factor ◽

Colonial Period ◽

Sub Saharan Africa ◽

Negative Consequences ◽

Post Colonial ◽

Republic Of The Congo ◽

Sub Saharan ◽

The Republic ◽

The Impact

The article considers the impact of the colonial past of some countries in sub-Saharan Africa and its effect on their development during the post-colonial period. The negative consequences of the geopolitical legacy of colonialism are shown on the example of three countries: Nigeria, the Democratic Republic of the Congo and the Republic of Angola, expressed in the emergence of conflicts in these countries based on ethno-cultural, religious and socio-economic contradictions. At the same time, the focus is made on the economic factor and the consequences of the consumer policy of the former metropolises pursuing their mercantile interests were mixed.

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The Impact of HIV on Economic Growth in Sub-Saharan Africa: Evidence of Spatial Externalities

SSRN Electronic Journal ◽

10.2139/ssrn.2257696 ◽

2012 ◽

Author(s):

Enrico Lovasz

Keyword(s):

Economic Growth ◽

Sub Saharan Africa ◽

Spatial Externalities ◽

Sub Saharan ◽

The Impact

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The Impact of the TRIPS Agreement on the Access to Antiretroviral Therapy in Sub-Saharan Africa

SSRN Electronic Journal ◽

10.2139/ssrn.2669097 ◽

2015 ◽

Author(s):

Joaquim Campoy Rubio

Keyword(s):

Antiretroviral Therapy ◽

Trips Agreement ◽

Sub Saharan Africa ◽

Sub Saharan ◽

The Impact

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The impact and cost‐effectiveness of community‐basedHIVself‐testing in sub‐Saharan Africa: a health economic and modelling analysis

Journal of the International AIDS Society ◽

10.1002/jia2.25243 ◽

2019 ◽

Vol 22 (S1) ◽

pp. e25243 ◽

Cited By ~ 13

Author(s):

Valentina Cambiano ◽

Cheryl C Johnson ◽

Karin Hatzold ◽

Fern Terris‐Prestholt ◽

Hendy Maheswaran ◽

...

Keyword(s):

Health Economic ◽

Cost Effectiveness ◽

Sub Saharan Africa ◽

Modelling Analysis ◽

Sub Saharan ◽

The Impact

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Financial Inclusion, Income Inequality and Sustainable Economic Growth in Sub-Saharan African Countries

Sustainability ◽

10.3390/su13041780 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1780

Author(s):

Chima M. Menyelim ◽

Abiola A. Babajide ◽

Alexander E. Omankhanlen ◽

Benjamin I. Ehikioya

Keyword(s):

Economic Growth ◽

Income Inequality ◽

Financial Services ◽

Sub Saharan Africa ◽

Kuznets Curve ◽

African Countries ◽

Financial Access ◽

Sub Saharan ◽

Sustainable Economic Growth ◽

The Impact

This study evaluates the relevance of inclusive financial access in moderating the effect of income inequality on economic growth in 48 countries in Sub-Saharan Africa (SSA) for the period 1995 to 2017. The findings using the Generalised Method of Moments (sys-GMM) technique show that inclusive financial access contributes to reducing inequality in the short run, contrary to the Kuznets curve. The result reveals a negative effect of financial access on the relationship between income inequality and economic growth. There is a positive net effect of inclusive financial access in moderating the impact of income inequality on economic growth. Given the need to achieve the Sustainable Development Targets in the sub-region, policymakers and other stakeholders of the economy must design policies and programmes that would enhance access to financial services as an essential mechanism to reduce income disparity and enhance sustainable economic growth.

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Mapping 20 Years of Urban Expansion in 45 Urban Areas of Sub-Saharan Africa

Remote Sensing ◽

10.3390/rs13030525 ◽

2021 ◽

Vol 13 (3) ◽

pp. 525

Author(s):

Yann Forget ◽

Michal Shimoni ◽

Marius Gilbert ◽

Catherine Linard

Keyword(s):

Case Studies ◽

Urban Areas ◽

Urban Expansion ◽

Local Population ◽

Sub Saharan Africa ◽

Annual Growth Rate ◽

Urban Dynamics ◽

Mapping Approach ◽

Sub Saharan ◽

The Impact

By 2050, half of the net increase in the world’s population is expected to reside in sub-Saharan Africa (SSA), driving high urbanization rates and drastic land cover changes. However, the data-scarce environment of SSA limits our understanding of the urban dynamics in the region. In this context, Earth Observation (EO) is an opportunity to gather accurate and up-to-date spatial information on urban extents. During the last decade, the adoption of open-access policies by major EO programs (CBERS, Landsat, Sentinel) has allowed the production of several global high resolution (10–30 m) maps of human settlements. However, mapping accuracies in SSA are usually lower, limited by the lack of reference datasets to support the training and the validation of the classification models. Here we propose a mapping approach based on multi-sensor satellite imagery (Landsat, Sentinel-1, Envisat, ERS) and volunteered geographic information (OpenStreetMap) to solve the challenges of urban remote sensing in SSA. The proposed mapping approach is assessed in 17 case studies for an average F1-score of 0.93, and applied in 45 urban areas of SSA to produce a dataset of urban expansion from 1995 to 2015. Across the case studies, built-up areas averaged a compound annual growth rate of 5.5% between 1995 and 2015. The comparison with local population dynamics reveals the heterogeneity of urban dynamics in SSA. Overall, population densities in built-up areas are decreasing. However, the impact of population growth on urban expansion differs depending on the size of the urban area and its income class.

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Prevalence of mastitis in Nigerian livestock: a Review

Open Veterinary Science ◽

10.1515/ovs-2020-0101 ◽

2020 ◽

Vol 1 (1) ◽

pp. 20-29

Author(s):

Hussaini Ojagefu Adamu ◽

Rahimat Oshuwa Hussaini ◽

Cedric Obasuyi ◽

Linus Irefo Anagha ◽

Gabriel Oscy Okoduwa

Keyword(s):

Control Strategies ◽

Dairy Farms ◽

Livestock Production ◽

Sub Saharan Africa ◽

Economic Losses ◽

Ecological Development ◽

Management Plans ◽

Sub Saharan ◽

Control And Management ◽

The Impact

AbstractMastitis is a disease of livestock that directly impede livestock production and thus hindering the socio-ecological development of sub-Saharan Africa. Studies have estimated the prevalence of this disease in 30% of Africa countries, with Ethiopia having the highest prevalence. The coverage is low, despite the wide livestock and dairy farms distribution in Africa. Furthermore, estimated economic losses due to the impact of mastitis are lacking in Nigeria. The disease is endemic in Nigeria as indicated by the available data and there are no proposed management plans or control strategies. This review is thus presented to serve as a wakeup call to all parties involved to intensify efforts towards the diagnosis, control, and management of the disease in Nigeria.

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