Normal values of aortic root diameters in sub saharan africans: the TAHES study

Abstract Introduction Reference values of aortic root diameters (ARD) are proposed to define normal versus diseased aorta. However, reported ranges of normal values are mostly issued from Caucasian cohorts. Data on blacks African subjects are sparse and not issued from community-dwelling cohorts. Purpose Our study aimed to establish reference values for ARD in a Beninese general population cohort. Methods This study is a part of TAHES, a population-based prospective cohort study initiated in 2015 in the district of Tanvè, Republic of Benin. Demographic, blood pressure and blood glucose data were collected using a questionnaire adapted from WHO-STEPS tools. Transthoracic echocardiography examinations were performed by 4 cardiologists, and analyzed off-line by a single observer. ARD were measured using inner-edge to inner-edge diameters during diastole for sinuses of Vasalva (SV), sinotubular junction (STJ) and proximal ascending aorta (AA), and during systole for annulus. Normal limits were defined as the 95th percentiles. Variables are presented as mean ±SD (5th-95th percentiles). Results We included 513 normotensive, non-diabetic and cardiovascular disease-free individuals (206 men and 307 women, age 40±14 years [26–68]). The absolute values of ARD were significantly greater in men: the non-indexed ARD values for the annulus, SV, STJ and AA were respectively 21.3±2 (18.5–25), 28.5±3.4 (23–34), 24.1±3 (19–29) and 27±3 (22.5–32) mm for men and 19.3±1.8 (1.8 (15- 22), 25.8±2.8 (21.6–30), 22±2.7 (18–26) and 24.8±2.8 (21–30) mm for women, respectively (all p<0.0001). No significant differences between sexes were recorded for body surface area (BSA)-indexed ARD for Annulus, STJ and AA. BSA-indexed SV dimension was greater in men (17.3±2.6 mm; 13.5–22) than women (16.8±2.5 mm; 13–21). There was a correlation between SV, STJ, AA indexed-diameters and age in both sexes but not for annulus indexed-diameter (r=0.14, 0.19 and 0.36 for women and 0.34, 0.45 and 0.32 for men, all p<0.05). The upper limits for ARD are summarized in Table 1. In order to compare these values to those in Caucasians, the data of the NORRE study are also displayed. Conclusion Normal values from a general population in West Africa appear could to differ from those established in Caucasian populations. This ethnic-appropriate reference is proposed for appropriate diagnosis in patients in sub-Saharan Africa. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): APREL (CHU Limoges) Table 1

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Excessive premature mortality among children with cerebral palsy in rural Uganda: A longitudinal, population-based study

PLoS ONE ◽

10.1371/journal.pone.0243948 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243948

Author(s):

Lukia H. Namaganda ◽

Rita Almeida ◽

Dan Kajungu ◽

Fred Wabwire-Mangen ◽

Stefan Peterson ◽

...

Keyword(s):

Cerebral Palsy ◽

General Population ◽

Population Based ◽

Sub Saharan Africa ◽

Severe Malnutrition ◽

Motor Impairments ◽

Population Based Study ◽

Risk Of Death ◽

Children With Cerebral Palsy ◽

Sub Saharan

Background Studies from high-income countries reported reduced life expectancy in children with cerebral palsy (CP), while no population-based study has evaluated mortality of children with CP in sub-Saharan Africa. This study aimed to estimate the mortality rate (MR) of children with CP in a rural region of Uganda and identify risk factors and causes of death (CODs). Methods and findings This population-based, longitudinal cohort study was based on data from Iganga-Mayuge Health and Demographic Surveillance System in eastern Uganda. We identified 97 children (aged 2–17 years) with CP in 2015, whom we followed to 2019. They were compared with an age-matched cohort from the general population (n = 41 319). MRs, MR ratios (MRRs), hazard ratios (HRs), and immediate CODs were determined. MR was 3952 per 100 000 person years (95% CI 2212–6519) in children with CP and 137 per 100 000 person years (95% CI 117–159) in the general population. Standardized MRR was 25·3 in the CP cohort, compared with the general population. In children with CP, risk of death was higher in those with severe gross motor impairments than in those with milder impairments (HR 6·8; p = 0·007) and in those with severe malnutrition than in those less malnourished (HR = 3·7; p = 0·052). MR was higher in females in the CP cohort, with a higher MRR in females (53·0; 95% CI 26·4–106·3) than in males (16·3; 95% CI 7·2–37·2). Age had no significant effect on MR in the CP cohort, but MRR was higher at 10–18 years (39·6; 95% CI 14·2–110·0) than at 2–6 years (21·0; 95% CI 10·2–43·2). Anaemia, malaria, and other infections were the most common CODs in the CP cohort. Conclusions Risk of premature death was excessively high in children with CP in rural sub-Saharan Africa, especially in those with severe motor impairments or malnutrition. While global childhood mortality has significantly decreased during recent decades, this observed excessive mortality is a hidden humanitarian crisis that needs to be addressed.

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Cervical Cancer in Sub-Saharan Africa – a multinational population-based study on treatment guideline adherence

10.1055/s-0039-1692081 ◽

2019 ◽

Author(s):

M Griesel ◽

DM Parkin ◽

C Thomssen ◽

EJ Kantelhardt

Keyword(s):

Cervical Cancer ◽

Guideline Adherence ◽

Treatment Guideline ◽

Population Based ◽

Sub Saharan Africa ◽

Population Based Study ◽

Sub Saharan

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Faculty Opinions recommendation of Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA).

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718011477.793479984 ◽

2013 ◽

Author(s):

Anthony Harries

Keyword(s):

Hiv Infection ◽

Population Based ◽

Sub Saharan Africa ◽

Community Based ◽

Secondary Analyses ◽

Sub Saharan ◽

Related Mortality ◽

Hiv Aids

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Cervical cancer in Sub‐Saharan Africa: a multinational population‐based cohort study on patterns and guideline adherence of care

The Oncologist ◽

10.1002/onco.13718 ◽

2021 ◽

Author(s):

Mirko Griesel ◽

Tobias P Seraphin ◽

Nikolaus CS Mezger ◽

Lucia Hämmerl ◽

Jana Feuchtner ◽

...

Keyword(s):

Cervical Cancer ◽

Cohort Study ◽

Guideline Adherence ◽

Population Based ◽

Sub Saharan Africa ◽

Sub Saharan

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Electrocardiographic Reference Values for a Population of Older Adults in Sub-Saharan Africa

Annals of Noninvasive Electrocardiology ◽

10.1111/anec.12078 ◽

2013 ◽

Vol 19 (1) ◽

pp. 34-42 ◽

Cited By ~ 8

Author(s):

Matthew J. Dewhurst ◽

Luigi Y. Di Marco ◽

Felicity Dewhurst ◽

Philip C. Adams ◽

Alan Murray ◽

...

Keyword(s):

Older Adults ◽

Reference Values ◽

Sub Saharan Africa ◽

Sub Saharan

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Establishing Cutoffs for Streptococcal Antibody Titers in Uganda: Implications for Rheumatic Fever Diagnosis

10.1101/19010447 ◽

2019 ◽

Author(s):

Emmy Okello ◽

Meghna Murali ◽

Joselyn Rwebembera ◽

Jenifer Atala ◽

Nada Harik ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Fever ◽

Rheumatic Heart Disease ◽

Normal Values ◽

Sub Saharan Africa ◽

Age Group ◽

Upper Limit ◽

Antibody Titers ◽

Sub Saharan ◽

Rheumatic Heart

AbstractBackgroundCentral to rheumatic fever (RF) diagnosis is evidence of streptococcal exposure, specifically antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies. It is unknown if these antibody titers should be adjusted to the background exposure rates of GAS or if published standards should be used. Here, we establish the normal values of ASO and ADB in Uganda and examine RF case detection using published vs. population-specific thresholds.MethodsParticipants (age 0-50 years) were recruited. ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for ADB determination by enzyme inhibition assay, andthe 80% upper limit values by age were established. The published standard values for ASO (200IU/ml) and ADB (375IU/ml) were compared to the Ugandan 80% upper limit of normal values (ULN) for RF case detection in children 5-15 years.FindingsOf the 428 participants, 16 were excluded from analysis (9 sore throat, 1 skin sores, 5 fever, 4 echocardiograms showing occult RHD), and 183 of the remaining were children 5-15 years. The median ASO titer in this age group was 220 IU/ml, with the 80th percentile value of 389 IU/ml. The median ADB titer in this age group was 375 IU/ml, with the 80th percentile value of 568 IU/ml. Application of new Ugandan cutoffs to 528 children enrolled in our prospective RF study, reduced the number of definite RF cases to 120/528 (22·7%), as compared to 173/528 (32·8%) using published normal values.InterpretationThe 80th percentile ULN for ASO and ADB are higher in Uganda than in other countries. Applying these higher values to RF diagnosis in Uganda results in higher diagnostic specificity, but some unknown loss in sensitivity. Implications of over-diagnosis and missed cases will be explored through a longitudinal follow-up study of children in the RF research program.FundingThis work was supported by American Heart Association Grant #17SFRN33670607 / Andrea Beaton / 2017 and DELTAS Africa Initiative.Research in contextEvidence before this studyWe searched PubMed for data on normal values of streptococcal antibody titers within diverse populations between database inception and January 1, 2019, using the search terms (rheumatic fever) OR (streptococcal antibodies). Nine studies were identified, but only one was from sub-Saharan Africa (2018, Ethiopia) and it was limited by vague exclusion criteria and lack of data on anti-DNase B. Given the high burden of rheumatic heart disease in sub-Saharan Africa, further data is needed to determine normal streptococcal antibody titers in this population and to assess the clinical impact of different cutoffs for RF diagnosis.Added value of this studyOur study utilized a rigorous approach to exclude patients with history of recent possible streptococcal exposure including skin and throat infection and employed echocardiography to exclude patients with pre-existing rheumatic heart disease. Additionally, this study was conducted in parallel to a larger epidemiological cohort study of rheumatic fever in Uganda, allowing us, for the first time, to prospectively determine how utilization of different streptococcal antibody titer cutoffs affect diagnosis of rheumatic fever.Implications of all the available evidenceRheumatic fever remains a challenging diagnosis based on a clinical decision rule with imperfect sensitivity and specificity. Improved understanding of streptococcal antibody titers in rheumatic heart disease endemic populations may improve diagnostic performance. Our study also points to the need for development of a rheumatic fever diagnostic test, in order to provide a more definitive assessment of risk.

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Cohort profile: The Chikwawa lung health cohort; a population-based observational non-communicable respiratory disease study in Malawi

10.1101/2020.04.16.20068643 ◽

2020 ◽

Author(s):

Martin Njoroge ◽

Sarah Rylance ◽

Rebecca Nightingale ◽

Stephen Gordon ◽

Kevin Mortimer ◽

...

Keyword(s):

Health Economic ◽

Lung Function ◽

Low Income ◽

Respiratory Symptoms ◽

Population Based ◽

Sub Saharan Africa ◽

Rural Setting ◽

Sub Saharan ◽

Lung Health

AbstractPurposeThe Chikwawa lung health cohort was established in rural Malawi in 2014 to prospectively determine the prevalence and causes of lung disease amongst the general population of adults living in a low-income rural setting in Sub-Saharan Africa.ParticipantsA total of 1481 participants were randomly identified and recruited in 2014 for the baseline study. We collected data on demographic, socio-economic status, respiratory symptoms and potentially relevant exposures such as smoking, household fuels, environmental exposures, occupational history/exposures, dietary intake, healthcare utilization, cost (medication, outpatient visits and inpatient admissions) and productivity losses. Spirometry was performed to assess lung function. At baseline, 56.9% of the participants were female, a mean age of 43.8 (SD:17.8) and mean body mass index (BMI) of 21.6 Kg/m2 (SD: 3.46)Findings to dateCurrently, two studies have been published. The first reported the prevalence of chronic respiratory symptoms (13.6%, 95% confidence interval [CI], 11.9 – 15.4), spirometric obstruction (8.7%, 95% CI, 7.0 – 10.7), and spirometric restriction (34.8%, 95% CI, 31.7 – 38.0). The second reported annual decline in forced expiratory volume in one second [FEV1] of 30.9mL/year (95% CI: 21.6 to 40.1) and forced vital capacity [FVC] by 38.3 mL/year (95% CI: 28.5 to 48.1).Future plansThe ongoing current phase of follow-up will determine the annual rate of decline in lung function as measured through spirometry, and relate this to morbidity, mortality and economic cost of airflow obstruction and restriction. Population-based mathematical models will be developed driven by the empirical data from the cohort and national population data for Malawi to assess the effects of interventions and programmes to address the lung burden in Malawi. The present follow-up study started in 2019.Strengths and limitations of this studyThis is an original cohort study comprising adults randomly identified in a low-income Sub-Saharan African Setting.The repeated follow up of the cohort has included objective measures of lung function.The cohort has had high rates of case ascertainment that include verbal autopsies.The study will include an analysis of the health economic consequences of rate of change of lung function and health economic modelling of impact of lung diseases and potential interventions that could be adopted.A main limitation of our study is the systematic bias may be introduced through the self-selection of the participants who agreed to take part in the study to date and the migration of individuals from Chikwawa.

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Neurocysticercosis – A Journey from Pre-independence to Modern India

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0040-1712609 ◽

2016 ◽

Vol 52 (02) ◽

pp. 076-099

Author(s):

Gagandeep Singh ◽

Monika Singla

Keyword(s):

Indian Subcontinent ◽

Taenia Solium ◽

Population Based ◽

Sub Saharan Africa ◽

Ct Scans ◽

Common Finding ◽

Cns Involvement ◽

High Prevalence ◽

Endemic Areas ◽

Sub Saharan

ABSTRACTNeurocysticercosis (NCC) is infestation of the human brain by the larva of worm, Taenia solium and is the most prevalent central nervous system (CNS) helminthiasis. The disease is widespread in tropical and subtropical regions of the world, including the Indian subcontinent, China, Sub-Saharan Africa, Central and South America and contributes substantially to the burden of epilepsy in these areas(1) . CNS involvement is seen in 60-90% of systemic cysticercosis. About 2.5 million people worldwide are infected with T. solium, and antibodies to T. solium are seen in up to 25% of people in endemic areas(1-3) . A higher prevalence of epilepsy and seizures in endemic countries is partly because of a high prevalence of cysticercosis in these regions. Seizures are thought to be caused by NCC in as many as 30% of adult patients and in 51% of children in population based endemic regions (2) . About 12% of admissions to neurological services in endemic regions are attributed to NCC and nearly half a million deaths occurring annually worldwide can be attributed directly or indirectly to NCC (Bern et al.). Punctate calcific foci on CT scan are a very common finding in asymptomatic people residing in endemic areas, found in 14-20 % of CT scans. Both seizures and positive cysticercus serology are associated with the detection of cysticerci on CT scans. Seroprevalence using a recently developed CDC- based enzyme-linked immunotransfer blot (EITB) assay is estimated at 8-12% in Latin America and 4.9-24% in Africa and South-East Asia. It is estimated that 20 million people harbour neurocysticercosis worldwide(1) .

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Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study

Current Developments in Nutrition ◽

10.1093/cdn/nzz120 ◽

2019 ◽

Vol 3 (12) ◽

Cited By ~ 5

Author(s):

Djibril M Ba ◽

Paddy Ssentongo ◽

Kristen H Kjerulff ◽

Muzi Na ◽

Guodong Liu ◽

...

Keyword(s):

Pregnant Women ◽

Iron Supplementation ◽

Population Based ◽

Sub Saharan Africa ◽

Deficiency Anemia ◽

Demographic And Health Surveys ◽

Factors Associated ◽

Sub Saharan ◽

Ssa Countries ◽

Antenatal Visits

ABSTRACT Background Iron deficiency anemia during pregnancy is a significant public health problem in sub-Saharan Africa (SSA) and is associated with serious adverse health outcomes. Although it is recommended that all women receive iron supplementation during pregnancy, little research has been conducted to measure overall compliance with this recommendation or variation across SSA countries. Objectives To assess prevalence and sociodemographic-economic factors associated with adherence to iron supplementation among pregnant women in SSA. Methods This was a weighted population-based cross-sectional study of 148,528 pregnant women aged 15–49 y in 22 SSA countries that participated in the Demographic and Health Surveys (DHS) in 2013–2018 and measured iron supplementation during pregnancy. Adherence to iron supplementation was defined as using iron supplementation for ≥90 d during pregnancy of the most recent birth. Results The overall prevalence of adherence to ≥90 d of iron supplementation during pregnancy was 28.7%, ranging from 1.4% in Burundi to 73.0% in Senegal. Factors associated with adherence included receiving ≥4 antenatal care visits [adjusted Prevalence Ratio (aPR): 25.73; 95% CI: 22.36, 29.60] compared with no antenatal visits; secondary or higher education (aPR: 1.17; 95% CI: 1.14, 1.19) compared with no education; wealthy (aPR: 1.13; 95% CI: 1.10, 1.16) compared with poor; and older women aged 35–49 y (aPR: 1.07; 95% CI: 1.05, 1.10) compared with younger women aged 15–24 y. Conclusions Adherence to iron supplementation during pregnancy in SSA is low and varies substantially across countries and in relation to factors such as number of antenatal visits, education, and level of family wealth. These results underscore the need for increased efforts to improve the uptake of iron supplementation for pregnant women in SSA.

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