A Good Start to Lowering BP and CVD Risk in Sub-Saharan Africa

IntroductionCardiovascular disease (CVD) risk factors are increasing in sub-Saharan Africa. The impact of these risk factors on future CVD outcomes and burden is poorly understood. We examined the magnitude of modifiable risk factors, estimated future CVD risk and compared results between three commonly used 10-year CVD risk factor algorithms and their variants in four African countries.MethodsIn the Africa-Wits-INDEPTH partnership for Genomic studies (the AWI-Gen Study), 10 349 randomly sampled individuals aged 40–60 years from six sites participated in a survey, with blood pressure, blood glucose and lipid levels measured. Using these data, 10-year CVD risk estimates using Framingham, Globorisk and WHO-CVD and their office-based variants were generated. Differences in future CVD risk and results by algorithm are described using kappa and coefficients to examine agreement and correlations, respectively.ResultsThe 10-year CVD risk across all participants in all sites varied from 2.6% (95% CI: 1.6% to 4.1%) using the WHO-CVD lab algorithm to 6.5% (95% CI: 3.7% to 11.4%) using the Framingham office algorithm, with substantial differences in risk between sites. The highest risk was in South African settings (in urban Soweto: 8.9% (IQR: 5.3–15.3)). Agreement between algorithms was low to moderate (kappa from 0.03 to 0.55) and correlations ranged between 0.28 and 0.70. Depending on the algorithm used, those at high risk (defined as risk of 10-year CVD event >20%) who were under treatment for a modifiable risk factor ranged from 19.2% to 33.9%, with substantial variation by both sex and site.ConclusionThe African sites in this study are at different stages of an ongoing epidemiological transition as evidenced by both risk factor levels and estimated 10-year CVD risk. There is low correlation and disparate levels of population risk, predicted by different risk algorithms, within sites. Validating existing risk algorithms or designing context-specific 10-year CVD risk algorithms is essential for accurately defining population risk and targeting national policies and individual CVD treatment on the African continent.

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Cardiovascular Disease Healthcare Utilization in Sub-Saharan Africa: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030419 ◽

2019 ◽

Vol 16 (3) ◽

pp. 419 ◽

Cited By ~ 3

Author(s):

Herbert Chikafu ◽

Moses Chimbari

Keyword(s):

Cardiovascular Disease ◽

Healthcare Utilization ◽

Hospital Admissions ◽

Stroke Care ◽

Sub Saharan Africa ◽

Quantitative Methodology ◽

Healthcare Provision ◽

Cvd Risk ◽

Epidemiological Transitions ◽

Sub Saharan

Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008–2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.

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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)

10.21203/rs.3.rs-25100/v4 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background: Few studies have characterized epidemiology and management of hypertension across several communities with comparable methodology 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. We collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using digital blood pressure monitors and following a standardized protocol. We estimated 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, and 32·7% were overweight/obese. A quarter of the participants (25·1% had hypertension, half of whom (57·6%) were diagnosed. Among 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 risk of 20% or greater while 7·1% had risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of adults had hypertension, about 40% were unaware, half of those aware were treated and half of those treated were controlled blood pressure. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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971Ethnicity and Cardiovascular Disease in the Australian Population

International Journal of Epidemiology ◽

10.1093/ije/dyab168.215 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Ekavi Georgousopoulou ◽

Sally Lord

Keyword(s):

Risk Prediction ◽

North Africa ◽

Ethnic Background ◽

Sub Saharan Africa ◽

Country Of Birth ◽

Cvd Risk ◽

North West ◽

North East ◽

Risk Charts ◽

Sub Saharan

Abstract Focus of Presentation Cardiovascular disease (CVD) risk prediction is recommended for Australians over 45 and Indigenous Australians over 35 years of age. UK evidence for the QRISK tool suggests that including ethnic background as a moderator, improves risk prediction. Australian risk-charts do not account for ethnicity, despite the diversity of the population. Our aim was to compare CVD prevalence among Australian ethnic groups, defined by country of birth and summarized in the following regions: 1.Oceania and Antarctica, 2.North-West-, 3.Southern and Eastern Europe, 4.North Africa and Middle East, 5.South-East-, 6.North-East-, 7.Southern and Central Asia, 8.America and 9.Sub-Saharan Africa. Findings Aggregated data from the Australian Health Survey Core Content–Risk Factors and Health Conditions 2011-12 TableBuilder of Australian Bureau of Statistics were representative of approximately 21.5M Australians according to weights’ analysis; however, age standardisation was impossible. Ischemic CVD prevalence for Australians born in Oceania and Antarctica was approximately 2.6%, North-West Europe 5.1%, Southern and Eastern Europe 6.7%, North Africa and Middle East 4.3%, South-East Asia 1.3%, north-East Asia 0.3%, South and Central Asia 1.2%, America 2.3% and Sub-Saharan Africa 1.2%. In all ethnic sub-groups, males represented 51-83% of individuals with CVD. Conclusions/Implications Country of birth may be used as a proxy of ethnic background for investigating potential socio-cultural CVD risk factors and if accounted for, might increase risk-charts’ performance. Key messages Australians’ ethnic background is associated with CVD prevalence. Including ethnicity in risk-tools might increase accuracy in CVD risk prediction.

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Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES) - implementation evaluation at operational level

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.468 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

H Bastiaens

Keyword(s):

Sub Saharan Africa ◽

Implementation Barriers ◽

Cvd Risk ◽

Lifestyle Behaviour ◽

Implementation Evaluation ◽

Evaluation Approach ◽

Mixed Methods Evaluation ◽

Raising Awareness ◽

Implementation Context ◽

Sub Saharan

Abstract SPICES focuses on the primary prevention of CVDs in vulnerable populations in Europe and Sub-Saharan Africa by raising awareness regarding CVD and its risk factors and by supporting lifestyle behaviour change in primary care and community settings. It is an implementation project employing a mixed methods evaluation approach. The RE-AIM QuEST and CFIR frameworks are used to guide the evaluation of impact on lifestyle and actual CVD risk and describe implementation barriers and explain how implementation context may influence translation to different settings. The presentation will focus on how these frameworks were used in practice and across settings.

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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 ◽

10.1186/s12889-020-09829-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F. Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

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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Cardiovascular disease: the new epidemic in sub-Saharan Africa

Vascular ◽

10.1258/vasc.2011.ra0049 ◽

2011 ◽

Vol 19 (6) ◽

pp. 301-307 ◽

Cited By ~ 16

Author(s):

Ifechukwude Ikem ◽

Bauer E Sumpio

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Sub Saharan Africa ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Double Burden ◽

The Usa ◽

Acquired Immunodeficiency ◽

Sub Saharan ◽

Immunodeficiency Syndrome

Sub-Saharan Africa (SSA) is now facing a double burden of disease where patients are suffering from non-communicable diseases such as coronary heart disease, along with the burden of the current human immunodeficiency virus (HIV) epidemic. Due to this double burden, cardiovascular disease (CVD) prevention and treatment has been overlooked, allowing the rates to continue to rise unchecked. A series of searches were conducted using PubMed as the primary database. From these searches, journal articles were compiled that related to diabetes, obesity and smoking rates in SSA. Also, the prevalence of CVD in the USA was reviewed. Although the USA has higher rates of CVD now, the rates were on the decline compared with SSA. Due to ‘Westernization’ of SSA, the rates of CVD risk factors, such as diabetes, are expected to increase by 50%. Because of this, 80% of CVD deaths worldwide took place in developing countries like those in SSA. Although HIV/acquired immunodeficiency syndrome (AIDS) is the current epidemic in SSA, CVD disease poses a threat as the new epidemic because of the increasing rates of these CVD risk factors. Without combating this disease now, SSA is facing an epidemiological shift from AIDS to CVD being the leading cause of death.

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Cardiovascular Risk Factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

10.21203/rs.2.14187/v3 ◽

2020 ◽

Author(s):

Geofrey Musinguzi ◽

Rawlance Ndejjo ◽

Isaac Ssinabulya ◽

Hilde Bastiaens ◽

Harm van Marwijk ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Low Income ◽

Small Area ◽

Sub Saharan Africa ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Generalized Linear Modelling ◽

Sub Saharan

Abstract Introduction Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda. Methods A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25-70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS. Results Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity. Patterns and clustering were observed for some major risk factors for CVDs including hypertension, physical inactivity, smoking, and risk factor combination. Prevalence of unhealthy diet was very high across all parishes with no significant observable differences across areas. Conclusion Modifiable cardiovascular risk factors are common in this low income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored.

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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)

10.21203/rs.3.rs-25100/v2 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background: Few studies have characterized epidemiology and management of hypertension across several communities with comparable methodology 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. We collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using digital blood pressure monitors and following a standardized protocol. We estimated 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, and 32·7% were overweight/obese. A quarter of the participants (25·1% had hypertension, half of whom (57·6%) were diagnosed. Among 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 risk of 20% or greater while 7·1% had risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of adults had hypertension, about 40% were unaware, half of those aware were treated and half of those treated were controlled blood pressure. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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Cardiovascular Risk Factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

10.21203/rs.2.14187/v2 ◽

2020 ◽

Author(s):

Geofrey Musinguzi ◽

Rawlance Ndejjo ◽

Isaac Ssinabulya ◽

Hilde Bastiaens ◽

Harm van Marwijk ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Low Income ◽

Small Area ◽

Sub Saharan Africa ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Generalized Linear Modelling ◽

Sub Saharan

Abstract Introduction Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda. Methods A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25-70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS. Results Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity. Patterns and clustering were observed for some major risk factors for CVDs including hypertension, physical inactivity, smoking, and risk factor combination. Prevalence of unhealthy diet is very high across all parishes with no significant observable difference. Conclusion Modifiable cardiovascular risk factors are common in this low income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored.

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