High Blood Pressure in Sub-Saharan Africa: The Urgent Imperative for Prevention and Control

The Pan American Health Organization (PAHO) with the World Hypertension League has established the 17th May to promote the prevention and control of High Blood Pressure (HBP). Currently nearly 1.13 billion of adults suffer from HBP (blood pressure ≥140/90 mm Hg) worldwide. While HBP prevalence decreased in high income countries (HIC) between 1975 and 2015, the opposite trend was observed in low- and middle- income countries (LMIC). Particularly, in Latin American and Caribbean countries the prevalence decreased from 40.6% to 26.8% and from 26.8% to 19.4% for men and women between 45 to 49 years old respectively. However, in 2015, HBP accounted for 8.9 of the total of disability adjusted life years (DALYS) and was associated with 4.9 million, 2.0 million and 1.5 million deaths due to ischemic heart disease, hemorrhagic stroke and ischemic stroke respectively. Therefore, HBP is the leading cardiovascular risk factor worldwide. In Colombia, the last National Health Survey reported a global prevalence of 22.8% and nearly 60% for those between 60 and 69 years in 2007

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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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An Exploration of the Barriers in the Prevention and Control of High Blood Pressure Among West African Immigrants in Rhode Island

10.28971/532013un141 ◽

2013 ◽

Author(s):

Ntaobasi Udeh

Keyword(s):

Blood Pressure ◽

Pilot Study ◽

Rhode Island ◽

High Blood Pressure ◽

Prevention And Control ◽

African Immigrants ◽

West African ◽

Pressure Management ◽

West African Immigrants ◽

And Control

This is a report of a pilot study to explore the barriers to the prevention and control of high blood pressure by West African immigrants in Rhode Island. The incidence of high blood pressure is high in African Americans with many possible contributory factors documented. However, little is known about possible barriers to the control of high blood pressure among specific black ethnic populations such as West African immigrants living in Rhode Island. A qualitative research design employing a semi-structured interview was utilize to explore the issue. The barriers to high blood pressure management reported by these West Africans immigrants reported included: psychosocial stressors, inability to adopt lifestyle changes such as diet and exercise, belief system, and a lack of complete adherence to medication regimen. The study also highlighted the fact that some primary care providers for these patients are not following the recommended interventions for the management of high blood pressure in people of black ancestry. The findings of this pilot study support the need for provider use of available treatment guidelines for population from black ancestry and the necessity for adequate patient education in the areas of stress management strategies and lifestyle modification as adjuncts to medication prescribed for high blood pressure management.

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Latent class evaluation of the performance of serological tests for exposure to Brucella spp. in cattle, sheep, and goats in Tanzania

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009630 ◽

2021 ◽

Vol 15 (8) ◽

pp. e0009630

Author(s):

Rebecca F. Bodenham ◽

Stella Mazeri ◽

Sarah Cleaveland ◽

John A. Crump ◽

Folorunso O. Fasina ◽

...

Keyword(s):

Test Performance ◽

Prevention And Control ◽

Latent Class ◽

Sub Saharan Africa ◽

Diagnostic Tools ◽

Serological Tests ◽

Sheep And Goats ◽

Parallel Testing ◽

Sub Saharan ◽

And Control

Background Brucellosis is a neglected zoonosis endemic in many countries, including regions of sub-Saharan Africa. Evaluated diagnostic tools for the detection of exposure to Brucella spp. are important for disease surveillance and guiding prevention and control activities. Methods and findings Bayesian latent class analysis was used to evaluate performance of the Rose Bengal plate test (RBT) and a competitive ELISA (cELISA) in detecting Brucella spp. exposure at the individual animal-level for cattle, sheep, and goats in Tanzania. Median posterior estimates of RBT sensitivity were: 0.779 (95% Bayesian credibility interval (BCI): 0.570–0.894), 0.893 (0.636–0.989), and 0.807 (0.575–0.966), and for cELISA were: 0.623 (0.443–0.790), 0.409 (0.241–0.644), and 0.561 (0.376–0.713), for cattle, sheep, and goats, respectively. Sensitivity BCIs were wide, with the widest for cELISA in sheep. RBT and cELISA median posterior estimates of specificity were high across species models: RBT ranged between 0.989 (0.980–0.998) and 0.995 (0.985–0.999), and cELISA between 0.984 (0.974–0.995) and 0.996 (0.988–1). Each species model generated seroprevalence estimates for two livestock subpopulations, pastoralist and non-pastoralist. Pastoralist seroprevalence estimates were: 0.063 (0.045–0.090), 0.033 (0.018–0.049), and 0.051 (0.034–0.076), for cattle, sheep, and goats, respectively. Non-pastoralist seroprevalence estimates were below 0.01 for all species models. Series and parallel diagnostic approaches were evaluated. Parallel outperformed a series approach. Median posterior estimates for parallel testing were ≥0.920 (0.760–0.986) for sensitivity and ≥0.973 (0.955–0.992) for specificity, for all species models. Conclusions Our findings indicate that Brucella spp. surveillance in Tanzania using RBT and cELISA in parallel at the animal-level would give high test performance. There is a need to evaluate strategies for implementing parallel testing at the herd- and flock-level. Our findings can assist in generating robust Brucella spp. exposure estimates for livestock in Tanzania and wider sub-Saharan Africa. The adoption of locally evaluated robust diagnostic tests in setting-specific surveillance is an important step towards brucellosis prevention and control.

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Adherence to Management of High Blood Pressure: Recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control

Can J Public Health ◽

10.1007/bf03404491 ◽

1998 ◽

Vol 89 (5) ◽

pp. I5-I7 ◽

Cited By ~ 14

Author(s):

Arun Chockalingam ◽

Marilyn Bacher ◽

Norman Campbell ◽

Heather Cutler ◽

Aidan Drover ◽

...

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Prevention And Control ◽

And Control

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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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Analysis of COVID-19 Prevention and Control Modes and Effects

Frontiers of Economics in China ◽

10.54605/fec20210403 ◽

2021 ◽

Vol 16 (4) ◽

pp. 628-665

Author(s):

Jian Zhou ◽

◽

Xiaohui Lu ◽

Liang Ye ◽

Yu Shao ◽

...

Keyword(s):

Active Treatment ◽

Prevention And Control ◽

Sub Saharan Africa ◽

The Us ◽

The World ◽

Sub Saharan ◽

And Cluster Analysis ◽

And Control ◽

First Contact ◽

South Europe

This study evaluates COVID-19 prevention and control policies. Based on the simulation, we compare the effects of two major policies: contact restriction and active treatment. Through regression and cluster analysis, we classified 169 countries and regions in the world into 10 groups, among which five groups accounted for the major proportion: the ones with the labels “CHN (China) mode,” “SE (South Europe) mode,” “ENE-SSA (East & North Europe and Sub-Saharan Africa) mode,” “US (United States) mode,” and “DEU (Germany) mode”). Differences in the effects of the prevention and control of COVID-19 in typical countries in each mode are comprehensively investigated. The conclusions of this study can be summarized as follows: First, contact restriction outperforms active treatment in curbing the spread of COVID-19. Second, “CHN mode” ranks the highest level of epidemic control and emphasizes epidemic prevention and control more than economic stimulus, which is the opposite of the “US mode”. Regression analysis reveals that the differences in epidemics worldwide are caused by policy differences among modes.

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