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

Circulation ◽  
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.

scholarly journals High Blood Pressure in Sub-Saharan Africa: Why Prevention, Detection, and Control are Urgent and Important

2015 ◽  
Vol 17 (9) ◽  
pp. 663-667 ◽  
Author(s):  
Norm R.C. Campbell ◽  
Pascal Bovet ◽  
Aletta Elisabeth Schutte ◽  
Daniel Lemogoum ◽  
Armand Seraphin Nkwescheu
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
And Control

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

2021 ◽  
Author(s):  
Kishal Lukhna ◽  
Derek J. Hausenloy ◽  
Abdelbagi Sidahmed Ali ◽  
Abdullah Bajaber ◽  
Alistair Calver ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Clinical Outcomes ◽  
Sub Saharan Africa ◽  
Myocardial Infarct Size ◽  
Early Reperfusion ◽  
Remote Ischaemic Conditioning ◽  
Sub Saharan ◽  
The Impact ◽  
Ischaemic Conditioning

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.

Mortality Rates, Prevalence of Malnutrition, and Prevalence of Lost Pregnancies among the Drought-Ravaged Population of Tete Province, Mozambique

2007 ◽  
Vol 22 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Andre M.N. Renzaho
Keyword(s):  
Mortality Rate ◽  
Mortality Rates ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
Food Aid ◽  
Emergency Relief ◽  
Humanitarian Response ◽  
Crude Mortality ◽  
The Impact ◽  
Hiv Aids

AbstractBackground:Tete Province, Mozambique has experienced chronic food insecurity and a dramatic fall in livestock numbers due to the cyclic problems characterized by the floods in 2000 and severe droughts in 2002 and 2003. The Province has been a beneficiary of emergency relief programs, which have assisted >22% of the population. However, these programs were not based on sound epidemiological data, and they have not established baseline data against which to assess the impact of the programs.Objective:The objective of this study was to document mortality rates, causes of death, the prevalence of malnutrition, and the prevalence of lost pregnancies after 2.5 years of humanitarian response to the crisis.Methods:A two-stage, 30-cluster household survey was conducted in the Cahora Bassa and Changara districts from 22 October to 08 November 2004. A total of 838 households were surveyed, with a population size of 4,688 people.Results:Anthropometric data were collected among children 6–59 months of age. In addition, crude mortality rates (crude mortality rates), under five mortality rates (under 5 mortality rate), causes of deaths, and prevalence of lost pregnancies were determined among the sample population. The prevalence of malnutrition was 8.0% (95% confidence interval (CI) = 6.2–9.8%) for acute malnutrition, 26.9% (95% CI = 24.0–29.9%) for being underweight, and 37.0% (95% CI = 33.8–40.2%) for chronic malnutrition. Boys were more likely to be under-weight than were girls (odds ratio (OR) = 1.34; 95% CI = 1.00, 1.82;p <0.05) after controlling for a, household size, and food aid beneficiary status. Similarly, children 30–59 months of age were significantly less likely to suffer from acute malnutrition (OR = 0.45; 95% CI = 0.26, 0.79; p <0.01) and less likely to be underweight (OR = 0.37; 95% CI = 0.27, 0.51;p <0.01) than children 6–29 months of a, after adjusting for the other, aforementioned factors. The proportion of lost pregnancies was estimated at 7.7% (95% CI = 4.5–11.0%). A total of 215 deaths were reported during the year preceding the survey. Thirty-nine (18.1%) children <5 years of age died. The CMR was 1.23/10,000/day (95% CI = 1.08–1.38), and an under 5 mortality rate was 1.03/10,000/day (95% CI = 0.71–1.35). Diarrheal diseases, malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) accounted for more than two-thirds of all deaths.Conclusions:The observed CMR in Tete Province, Mozambique is three times higher than the baseline rate for sub-Saharan Africa and 1.4 times higher than the CMR cut-off point used to define excess mortality in emergencies.The current humanitarian response in Tete Province would benefit from an improved alignment of food aid programming in conjunction with diarrheal disease control, HIV/AIDS, and malaria prevention and treatment programs. The impact of the food programs would be improved if mutually acceptable food aid program objectives, verifiable indicators relevant to each objective, and beneficiary targets and selection criteria are developed. Periodic re-assessments and evaluations of the impact of the program and evidenced-based decision-making urgently are needed to avert a chronic dependency on food aid.

scholarly journals The impact of governance quality on mortality rates in Sub Saharan Africa

2019 ◽  
Vol 33 (1) ◽  
Author(s):  
Chimere O. Iheonu ◽  
Shedrach A Agbutun ◽  
Chinonyerem M Omenihu ◽  
Godfrey I Ihedimma ◽  
Vivian N Osuagwu
Keyword(s):  
Mortality Rates ◽  
Sub Saharan Africa ◽  
Governance Quality ◽  
Sub Saharan ◽  
The Impact

scholarly journals High Blood Pressure Confirmed with 24-Hour Ambulatory Blood Pressure Monitoring in Tanzanian Adolescents Enrolling in a Cohort Study

2020 ◽  
Author(s):  
Mussa Nsanya ◽  
Philip Ayieko ◽  
Ramadhan Hashim ◽  
Ezekiel Mgema ◽  
Daniel Fitzgerald ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Public Schools ◽  
High Blood Pressure ◽  
Cardiovascular Health ◽  
Blood Pressure Monitoring ◽  
Sub Saharan Africa ◽  
White Coat Hypertension ◽  
Sub Saharan

Abstract Prevalence estimates for high blood pressure (BP) among adolescents in sub-Saharan Africa vary widely and most studies have relied on attended automated office BP (AOBP) measurements. We aimed to estimate prevalence of high BP using unattended AOBP followed by 24-Hour ambulatory BP monitoring (24-Hour ABPM) for confirmation and to determine factors associated with confirmed high BP. Between April and August 2018, 500 adolescents aged 11 to 15 years were enrolled from three randomly selected public schools in Mwanza city (Tanzania) to participate in a 2-year prospective cohort study. We obtained three consecutive unattended AOBP measurements. Follow-up AOBP measurements were obtained in participants with high BP at initial measurements. Participants whose follow-up measurements remained high underwent 24-Hour ABPM. Of all 500 participants, 36.6% had high BP using first AOBP measurement; 25.6% using average of the second and third AOBP measurements and 10.2% using average of follow-up AOBP measurements and were eligible for 24-Hour ABPM. Only 13(2.6%) had confirmed high BP and they had no unique distinguishing characteristic. White coat hypertension is common among adolescents in Africa. Cardiovascular health promotion in Africa can be done through school-based screening for high BP among adolescents using one unattended AOBP

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

2015 ◽  
Vol 17 (10) ◽  
pp. 751-755 ◽  
Author(s):  
Justin B. Echouffo-Tcheugui ◽  
Andre P. Kengne ◽  
Sebhat Erqou ◽  
Richard S. Cooper
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Prevention And Control ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
And Control

scholarly journals Socio-economic and Demographic Covariates of Infant Mortality in Sub-Saharan Africa: Application of Analysis of Variance (ANOVA) and Multiple Regression Models

2018 ◽  
Vol 5 (7) ◽  
pp. 4849-4863
Author(s):  
Dr. Hadgu Bariagaber
Keyword(s):  
Infant Mortality ◽  
Correlation Matrix ◽  
Regression Models ◽  
Sub Saharan Africa ◽  
Clear Understanding ◽  
Fertility Level ◽  
Independent Variables ◽  
High Infant Mortality ◽  
Sub Saharan ◽  
The Impact

The main thrust of the study is investigate the main socio-economic and demographic antecedents and proximate factors influencing Infant Mortality Levels and Patterns in Sub-Saharan African The source of data of the study is largely from the 2001-2005 UNDP Human Development Reports, National Census Results, DHS data and Demographic survey results of Sub-Saharan African Countries. The analytical techniques include analysis of univariate and bivaraite frequency distributions,  ANOVA, correlation matrix  and Multivariate regression models. Each country is taken as the unit of observation and a total of 42 countries are covered. The dependent variable is the level of Infant Mortality whereas 14 independent variables as the predictors influencing the Infant Mortality conditions are considered.   The model outputs suggested that all the fourteen independent covariates appeared to influence the levels of infant mortality positively or negatively, but in varying values of statistical significance, due to multicollinearity among the independent variables as manifested in the correlation matrix which appear to hinder clear understanding of  the impact of each independent variable on infant mortality. However, the stepwise regression output identified the critical covariates of the infant mortality levels. In conclusion, the study indicated that persistent high infant mortality level in the African -Continent has yet to continue for some decades before coming down to acceptable levels. The main reasons which largely appeared to maintain high Infant Mortality Levels among the Sub-Saharan Countries were noted to be the widespread poverty conditions and low level of health services and education in rural Sub-Saharan Africa. Consequently, the high infant mortality in rural Africa has been observed to be influenced by high fertility level, family planning programmes, education and employment, among other background and proximate variables.

scholarly journals HIV treatment is associated with a twofold higher probability of raised triglycerides: pooled analyses in 21 023 individuals in sub-Saharan Africa

2018 ◽  
Vol 3 ◽  
Author(s):  
K. Ekoru ◽  
E. H. Young ◽  
D. G. Dillon ◽  
D. Gurdasani ◽  
N. Stehouwer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Models ◽  
Cardiometabolic Risk ◽  
Causal Effect ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Limited Data ◽  
Sub Saharan ◽  
The Impact

BackgroundAnti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.MethodsPooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.FindingsAmong 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.InterpretationEvidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.

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

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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