scholarly journals Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038520
Author(s):  
Maria Lisa Odland ◽  
Tahir Bockarie ◽  
Haja Wurie ◽  
Rashid Ansumana ◽  
Joseph Lamin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Access To Care ◽  
Sierra Leone ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Health System Strengthening ◽  
Low Income Countries

IntroductionPrevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions.MethodsThis study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested (‘screened’), knew of their condition (‘diagnosed’), were on treatment (‘treated’) or were controlled to target (‘controlled’). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded.ResultsOf 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost.ConclusionsIn Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.

scholarly journals Knowledge and understanding of cardiovascular disease risk factors in Sierra Leone: a qualitative study of patients’ and community leaders’ perceptions

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038523
Author(s):  
Agnieszka Ignatowicz ◽  
Maria Lisa Odland ◽  
Tahir Bockarie ◽  
Haja Wurie ◽  
Rashid Ansumana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Qualitative Study ◽  
Sierra Leone ◽  
Low Income ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cardiovascular Disease Risk Factors ◽  
Community Leaders ◽  
Major Barrier

ObjectivesPrevalence of cardiovascular disease risk factors (CVDRF) is increasing, especially in low-income countries. In Sierra Leone, there are no previous studies on the knowledge and the awareness of these conditions in the community. This study aimed to explore the knowledge and understanding of CVDRF, as well as the perceptions of the barriers and facilitators to accessing care for these conditions, among patients and community leaders in Sierra Leone.DesignQualitative study employing semistructured interviews and focus group discussions.SettingUrban and rural Bo District, Sierra Leone.ParticipantsInterviews with a purposive sample of 37 patients and two focus groups with six to nine community leaders.ResultsWhile participants possessed general knowledge of their conditions, the level and complexity of this knowledge varied widely. There were clear gaps in knowledge regarding the coexistence of CVDRF and their consequences, as well as the link between behavioural factors and CVDRF. An overarching theme from the data was the need to create an understanding and awareness of CVDRF in the community in order to prevent and improve management of these conditions. Cost was also seen as a major barrier to accessing care for CVDRFs.ConclusionsThe knowledge gaps identified in this study highlight the need to design strategies and interventions that improve knowledge and recognition of CVDRF in the community. Interventions should specifically consider how to develop and enhance awareness about CVDRF and their consequences. They should also consider how patients seek help and where they access it.

Epidemiology of Acute Kidney Injury

2017 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Elerson Carlos Costalonga ◽  
Emmanuel A. Burdmann
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Low Income ◽  
Rural Areas ◽  
Hospital Admissions ◽  
De Novo ◽  
Residual Disease ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Low Income Countries

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist. 

scholarly journals Shared Sanitation Management and the Role of Social Capital: Findings from an Urban Sanitation Intervention in Maputo, Mozambique

2018 ◽  
Vol 15 (10) ◽  
pp. 2222 ◽  
Author(s):  
Tess Shiras ◽  
Oliver Cumming ◽  
Joe Brown ◽  
Becelar Muneme ◽  
Rassul Nala ◽  
...  
Keyword(s):  
Social Capital ◽  
Low Income ◽  
Urban Areas ◽  
Management Practices ◽  
Disease Risk ◽  
Critical Role ◽  
Management Strategies ◽  
Formal System ◽  
Low Income Countries ◽  
Change Models

Shared sanitation—sanitation facilities shared by multiple households—is increasingly common in rapidly growing urban areas in low-income countries. However, shared sanitation facilities are often poorly maintained, dissuading regular use and potentially increasing disease risk. In a series of focus group discussions and in-depth interviews, we explored the determinants of shared sanitation management within the context of a larger-scale health impact evaluation of an improved, shared sanitation facility in Maputo, Mozambique. We identified a range of formal management practices users developed to maintain shared sanitation facilities, and found that management strategies were associated with perceived latrine quality. However—even within an intervention context—many users reported that there was no formal system for management of sanitation facilities at the compound level. Social capital played a critical role in the success of both formal and informal management strategies, and low social capital was associated with collective action failure. Shared sanitation facilities should consider ways to support social capital within target communities and identify simple, replicable behavior change models that are not dependent on complex social processes.

scholarly journals Screening Low-Income Women of Reproductive Age for Cardiovascular Disease Risk Factors

2013 ◽  
Vol 22 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Cheryl L. Robbins ◽  
Thomas C. Keyserling ◽  
Stephanie B. Jilcott Pitts ◽  
John Morrow ◽  
Nadya Majette ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Low Income ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Reproductive Age ◽  
Cardiovascular Disease Risk Factors ◽  
Women Of Reproductive Age ◽  
Low Income Women

scholarly journals Assessment of cardiovascular risk among adults in a rural area of Kancheepuram district, Tamil Nadu

2018 ◽  
Vol 5 (2) ◽  
pp. 698
Author(s):  
Velavan A. ◽  
Jyothi Vasudevan ◽  
Arun S. ◽  
Anil J. Purty ◽  
Vincent A.
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Low Income ◽  
Rural Areas ◽  
Tamil Nadu ◽  
Low Cost ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Cooking Oils

Background: Increasing longevity of the world’s population has resulted in a shift in the disease patterns prevalent hitherto. The worst affected are the middle and low- income countries including India. The genetic make-up of Indians render them highly susceptible to cardiovascular diseases and diabetes at a much earlier age with resultant higher mortality rates. Thus, low- cost early detection, and innovative, customized preventive strategies are the need of the hour. Methods: In this cross- sectional study, we have used the WHO/ISH risk prediction charts tailor – made for the SEAR D region, to assess the cardiovascular risk of a rural population aged above 40 years. Data regarding multiple cardiovascular risk factors were collected using a pre- defined and pre-tested questionnaire, from 400 participants, including other variables like BP and anthropometric measurements. The data were entered in Microsoft excel and analysed using SPSS- ver16. Results: We found that 14.5% of the population had more than 10% risk of cardiovascular diseases and 41.5% were in stage I or II hypertension. People who belonged to the class II SES, use of oral tobacco, saturated cooking oils and sedentary lifestyle was found to be associated with high CV risk. However the association of CV risk with other risk factors like smoking and BMI was inconsistent. Conclusions: There is an increasing trend of cardiovascular risk in rural areas of Tamil Nadu and risk factors like higher socio economic class, use of oral tobacco, saturated cooking oils and sedentary occupation were found to be associated with high CV risk.

Abstract P471: Citizenship Status and the Prevalence, Treatment, and Control of Cardiovascular Disease Risk Factors Among Immigrants in United States, 2011-2016

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jenny S Guadamuz ◽  
Ramon A Durazo-Arvizu ◽  
Martha L DAVIGLUS ◽  
Gregory Calip ◽  
Edith Nutescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Access To Care ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cvd Risk Factors ◽  
National Guidelines ◽  
Cvd Risk ◽  
Citizenship Status ◽  
And Control

Introduction: Immigrants without US citizenship, i.e., noncitizens, encounter barriers in accessing care which may contribute to disparities in cardiovascular disease (CVD), the leading cause of death among immigrants in the US. Despite this, little is known about whether the prevalence, treatment, and control of CVD risk factors differ by citizenship status This study estimates the prevalence, treatment, and control of CVD risk factors (hypercholesterolemia, hypertension, and diabetes) among US immigrants by citizenship status. Methods: We used nationally representative, cross-sectional data from the National Health and Nutrition Examination Survey (2011/12 to 2015/16), restricted to 5,306 immigrant adults (≥20 years). Citizenship status (exposure) was categorized as either citizen or noncitizen. CVD risk factor prevalence (age-standardized), treatment, and control were defined per national guidelines and determined using examinations and prescription-medication inventories. Treatment was estimated among persons with relevant conditions and control was estimated among persons who were receiving treatment. Associations were evaluated using Poisson regressions (prevalence ratios, PR). Results: Hypercholesterolemia (42.0%), hypertension (29.0%), and diabetes (15.7%) were common among immigrants and marginal differences were observed between citizens and noncitizens. However, noncitizens were less likely to be treated for hypercholesterolemia (16.4% vs. 43.3%, PR 0.38 [CI 0.31-0.46], P <0.001), hypertension (60.3% vs. 79.6%, PR 0.76 [CI 0.70-0.84], P <0.001), and diabetes (51.2% vs. 66.6%, PR 0.77 [CI 0.66-0.90], P <0.001) than citizens. Because noncitizens disproportionally lack a usual source of care (30.2% vs. 16.6%, P <0.001) and health insurance (48.8% vs. 19.1%, P <0.001), adjusting for access to care largely explained differences in the treatment of CVD risk factors. Among those treated for CVD risk factors, citizens and noncitizens achieved similar control of hypercholesterolemia (36.2%) and hypertension (67.5%), but disparities in diabetes control were observed (35.3% vs. 46.9% , P =0.04). Conclusions: While CVD risk factors were common in citizens and noncitizens, treatment rates were significantly lower among noncitizens due to poor access to care. Efforts to prevent CVD morbidity and mortality among immigrants should address the undertreatment of risk factors by ensuring access to care among immigrants, regardless of citizenship status.

Epidemiology of Acute Kidney Injury

2017 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Elerson Carlos Costalonga ◽  
Emmanuel A. Burdmann
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Low Income ◽  
Rural Areas ◽  
Hospital Admissions ◽  
De Novo ◽  
Residual Disease ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Low Income Countries

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist. 

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