Abstract P137: Socioeconomic Status And Hypertension Control In Sub-saharan Africa: The Multination Eight Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Marie Antignac ◽  
Diane Macquart de Terline ◽  
Ibrahima Bara Diop ◽  
Kouadio E Kramoh ◽  
Dadhi M Balde ◽  
...  
Keyword(s):  
Low Income ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Uncontrolled Hypertension ◽  
Hypertension Control ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Level ◽  
The World ◽  
Sub Saharan

Introduction: Systemic hypertension is a rapidly growing epidemic in Sub-Saharan Africa. Adequacy of blood pressure(BP) control and the factors influencing it, especially the role of socio-economic status(SES) have not been well studied in this part of the world. Hypothesis: We therefore aimed to quantify the association of SES both at the individual and at the country level with BP control in Sub-Saharan Africa. Methods: We conducted a cross-sectional survey in urban clinics of twelve countries, both low-income and middle-income, in Sub-Saharan Africa. Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP<140/90 mmHg and hypertension grades were defined according to European Society of Cardiology guidelines. Country income was retrieved from the World Bank database and patient’s individual wealth status was documented by the treating physician. The separate association between SES (both country-level income and individual patient wealth) and BP control was investigated using Generalized Linear Mixed-Effects Models adjusted on sex and age. Results: A total of 2198 hypertensive patients (58.4±11.8years; 39.9% male) were included, of whom 1017(46.3%) were from low-income and 1181(53.7%) from middle-income countries. Individual wealth level was low, mid and high in 376(17.6%), 1053(49.2%) and 713(33.3%) patients respectively. Uncontrolled hypertension was present in 1692 patients(77.4%) including 1044(47.7%) with ≥grade 2 hypertension. The proportion of uncontrolled hypertension progressively increased with decreasing level of patient individual wealth, respectively 72.8%, 79.3% and 81.8%(p for trend<0.01). Stratified analysis shows that these differences of uncontrolled hypertension according to individual wealth index were observed in low-income countries(p for trend=0.03) and not in middle-income countries(p for trend=0.26). In low-income countries the odds of uncontrolled hypertension increased 1.37 fold(OR=1.37 [0.99-1.90]) and 1.88 fold(OR=1.88 [1.10-3.21]) in patients with middle and low individual wealth as compared to high individual wealth. Similarly, the grade of hypertension increased progressively with decreasing level of individual patient wealth(p for trend <0.01). Conclusions: Low individual wealth was significantly associated with poor hypertension control, especially in low-income countries. Strategies for hypertension control in Sub-Saharan Africa should especially focus on people in the lowest individual wealth groups who also reside in low-income countries.

P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kane ◽  
P Cavagna ◽  
I B Diop ◽  
B Gaye ◽  
J B Mipinda ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Low Income ◽  
Democratic Republic ◽  
Antihypertensive Drugs ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sub Saharan

Abstract Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01). Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

scholarly journals Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data

2020 ◽  
Vol 5 (11) ◽  
pp. e003423
Author(s):  
Dongqing Wang ◽  
Molin Wang ◽  
Anne Marie Darling ◽  
Nandita Perumal ◽  
Enju Liu ◽  
...  
Keyword(s):  
Weight Gain ◽  
North Africa ◽  
Low Income ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Middle Income Countries ◽  
Gestational Weight ◽  
Latin America And Caribbean ◽  
Nationally Representative ◽  
Sub Saharan

IntroductionGestational weight gain (GWG) has important implications for maternal and child health and is an ideal modifiable factor for preconceptional and antenatal care. However, the average levels of GWG across all low-income and middle-income countries of the world have not been characterised using nationally representative data.MethodsGWG estimates across time were computed using data from the Demographic and Health Surveys Program. A hierarchical model was developed to estimate the mean total GWG in the year 2015 for all countries to facilitate cross-country comparison. Year and country-level covariates were used as predictors, and variable selection was guided by the model fit. The final model included year (restricted cubic splines), geographical super-region (as defined by the Global Burden of Disease Study), mean adult female body mass index, gross domestic product per capita and total fertility rate. Uncertainty ranges (URs) were generated using non-parametric bootstrapping and a multiple imputation approach. Estimates were also computed for each super-region and region.ResultsLatin America and Caribbean (11.80 kg (95% UR: 6.18, 17.41)) and Central Europe, Eastern Europe and Central Asia (11.19 kg (95% UR: 6.16, 16.21)) were the super-regions with the highest GWG estimates in 2015. Sub-Saharan Africa (6.64 kg (95% UR: 3.39, 9.88)) and North Africa and Middle East (6.80 kg (95% UR: 3.17, 10.43)) were the super-regions with the lowest estimates in 2015. With the exception of Latin America and Caribbean, all super-regions were below the minimum GWG recommendation for normal-weight women, with Sub-Saharan Africa and North Africa and Middle East estimated to meet less than 60% of the minimum recommendation.ConclusionThe levels of GWG are inadequate in most low-income and middle-income countries and regions. Longitudinal monitoring systems and population-based interventions are crucial to combat inadequate GWG in low-income and middle-income countries.

scholarly journals Is overseas volunteering beneficial to the NHS? The analysis of volunteers’ responses to a feedback questionnaire following experiences in low-income and middle-income countries

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017517 ◽  
Author(s):  
Daniel Yeomans ◽  
Grace Le ◽  
Hemant Pandit ◽  
Chris Lavy
Keyword(s):  
Professional Development ◽  
Low Income ◽  
Personal Development ◽  
Positive Impact ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Middle Income Countries ◽  
Feedback Questionnaire ◽  
Sub Saharan ◽  
The Uk

IntroductionLocally requested and planned overseas volunteering in low-income and middle-income countries by National Health Service (NHS) staff can have benefits for the host or receiving nation, but its impact on the professional development of NHS staff is not proven. The Knowledge and Skills Framework (KSF) and Leadership Framework (LF) are two tools used by employers as a measure of individuals' development. We have used dimensions from both tools as a method of evaluating the benefit to NHS doctors who volunteer overseas.Methods88 NHS volunteers participating with local colleagues in Primary Trauma Care and orthopaedic surgical training courses in sub-Saharan Africa were asked to complete an online self-assessment questionnaire 6 months following their return to the UK. The survey consisted of questions based on qualities outlined in both the KSF and LF.Results85 completed responses to the questionnaire were received. In every KSF domain assessed, the majority of volunteers agreed that their overseas volunteering experience improved their practice within the NHS. Self-assessed pre-course and post-course scores evaluating the LF also saw a universal increase, notably in the ‘working with others’ domain.DiscussionThere is a growing body of literature outlining the positive impact of overseas volunteering on NHS staff. Despite increasing evidence that such experiences can develop volunteers’ essential skills, individuals often find it difficult to gain support of their employers. Our study, in line with the current literature, shows that overseas volunteering by NHS staff can provide an opportunity to enhance professional and personal development. Skills gained from volunteering within international links match many of the qualities outlined in both KSF and LF, directly contributing to volunteers’ continued professional development.

Water Supply, Sanitation, and the Environment

2021 ◽  
Author(s):  
N. Vijay Jagannathan
Keyword(s):  
Water Supply ◽  
Low Income ◽  
Poor Performance ◽  
Low Income Countries ◽  
General Interest ◽  
Sustainable Development Goal ◽  
Middle Income ◽  
Development Goal ◽  
Middle Income Countries ◽  
The World

Sustainable Development Goal No. 6 (SDG 6) has committed all nations of the world to achieving ambitious water supply and sanitation targets by 2030 to meet the universal basic needs of humans and the environment. Many lower-middle-income countries and all low-income countries face an uphill challenge in achieving these ambitious targets. The cause of poor performance is explored, some possible ways to accelerate progress toward achieving SDG 6 are suggested. The analysis will be of interest to a three-part audience: (a) readers with a general interest on how SDG 6 can be achieved; (b) actors with policy interest on improving water supply and safe sanitation (WSS) service issues; and (c) activists skeptical of conventional WSS policy prescriptions who advocate out-of-the-box solutions to improve WSS delivery.

scholarly journals Developing nephrology services in low income countries: a case of Tanzania

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Francis F. Furia ◽  
Jacqueline Shoo ◽  
Paschal J. Ruggajo ◽  
Kajiru Kilonzo ◽  
Gopal Basu ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Low Income ◽  
Kidney Diseases ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Care Providers ◽  
African Countries ◽  
Middle Income ◽  
Sub Saharan

Abstract Background The burden of kidney diseases is reported to be higher in lower- and middle-income countries as compared to developed countries, and countries in sub-Saharan Africa are reported to be most affected. Health systems in most sub-Sahara African countries have limited capacity in the form of trained and skilled health care providers, diagnostic support, equipment and policies to provide nephrology services. Several initiatives have been implemented to support establishment of these services. Methods This is a situation analysis to examine the nephrology services in Tanzania. It was conducted by interviewing key personnel in institutions providing nephrology services aiming at describing available services and international collaborators supporting nephrology services. Results Tanzania is a low-income country in Sub-Saharan Africa with a population of more than 55 million that has seen remarkable improvement in the provision of nephrology services and these include increase in the number of nephrologists to 14 in 2018 from one in 2006, increase in number of dialysis units from one unit (0.03 unit per million) before 2007 to 28 units (0.5 units per million) in 2018 and improved diagnostic services with introduction of nephropathology services. Government of Tanzania has been providing kidney transplantation services by funding referral of donor and recipients abroad and has now introduced local transplantation services in two hospitals. There have been strong international collaborators who have supported nephrology services and establishment of nephrology training in Tanzania. Conclusion Tanzania has seen remarkable achievement in provision of nephrology services and provides an interesting model to be used in supporting nephrology services in low income countries.

scholarly journals The Rally-Intensive Campaign: A Distinct Form of Electioneering in Sub-Saharan Africa and Beyond

2019 ◽  
Vol 24 (4) ◽  
pp. 444-464 ◽  
Author(s):  
Dan Paget
Keyword(s):  
Low Income ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Ethnographic Research ◽  
Election Campaigns ◽  
The World ◽  
National Leaders ◽  
Sub Saharan ◽  
Original Survey ◽  
Local Party

I consider how to characterize and classify election campaigns in sub-Saharan Africa. I revisit the typology proposed by Pippa Norris, which distinguishes between premodern, modern, and postmodern campaigns. This typology, and others like it, homogenizes ground campaigns. Ground campaigns only feature by virtue of their centrality in premodern campaigns and their peripherality in modern and postmodern campaigns. I argue that the prominence of the rally varies across ground campaigns. By trivializing rallies, current typologies obscure this variation between African campaigns and between campaigns in sub-Saharan Africa and the rest of the world. To accommodate these differences, I propose a schema of campaign ecologies, adapted from Norris’ own, which incorporates a distinct ideal-type: the rally-intensive campaign. This revision internationalizes this hitherto Western-bound typology and may illuminate the features of campaigns in other middle- and low-income countries too. Equally, it throws into relief differences between historic premodern campaigns in Western countries. I contend that rally-intensiveness is a definitive feature of election campaigns from which other features stem. To illuminate such typical features, I study Tanzania, which has the most rally-intensive campaigns in Africa. I draw on ethnographic research and original survey data to identify the four following typical features of the rally-intensive campaign. Local as well as national leaders hold rallies frequently. Local rallies are better attended in aggregate than national ones, and accordingly, campaign contact is direct. Mass meetings dwarf the canvass as a means of campaign contact, and local party networks concentrate their efforts on “producing” rallies.

scholarly journals Acquired heart disease in low-income and middle-income countries

2017 ◽  
Vol 103 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Chris Curry ◽  
Liesl Zuhlke ◽  
Ana Mocumbi ◽  
Neil Kennedy
Keyword(s):  
Heart Disease ◽  
Low Income ◽  
Burden Of Illness ◽  
Sub Saharan Africa ◽  
Endomyocardial Fibrosis ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Middle Income Countries ◽  
Acquired Heart Disease ◽  
Sub Saharan

The burden of illness associated with acquired cardiac disease in children in low-income and middle-income countries (LMIC) is significant and may be equivalent to that of congenital heart disease. Rheumatic heart disease, endomyocardial fibrosis, cardiomyopathy (including HIV cardiomyopathy) and tuberculosis are the most important causes. All are associated with poverty with the neediest children having the least access to care. The associated mortality and morbidity is high. There is an urgent need to improve cardiac care in LMIC, particularly in sub-Saharan Africa and parts of Southeast Asia where the burden is highest.

scholarly journals Drivers of Financial Access

2020 ◽  
Vol 20 (74) ◽  
Author(s):  
Corinne Deléchat ◽  
Lama Kiyasseh ◽  
Margaux MacDonald ◽  
Rui Xu
Keyword(s):  
Low Income ◽  
Financial Services ◽  
Financial Stability ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Financial Access ◽  
Country Level ◽  
Macroprudential Policies ◽  
Sub Saharan ◽  
Emerging And Developing Countries

This study analyzes the drivers of the use of formal vs. informal financial services in emerging and developing countries using the 2017 Global FINDEX data. In particular, we investigate whether individuals’ choice of financial services correlates with macro-financial and macro-structural policies and conditions, in addition to individual and country characteristics. We start our analysis on middle and low-income countries, and then zoom in on sub-Saharan Africa, currently the region that most relies on informal financial services, and which has the largest uptake of mobile banking. We find robust evidence of an association between macroprudential policies and individuals’ choice of financial access after controlling for personal and country-level characteristics. In particular, macroprudential policies aimed at controlling credit supply seem to be associated with greater resort to informal financial services compared with formal, bank-based access. This highlights the importance for central bankers and financial sector regulators to consider the potential spillovers of monetary policy and financial stability measures on financial inclusion.

scholarly journals Sugar-sweetened beverage consumption in the early years and implications for type-2 diabetes: a sub-Saharan Africa context

2019 ◽  
Vol 78 (4) ◽  
pp. 547-553 ◽  
Author(s):  
Keiron Audain ◽  
Louis Levy ◽  
Basma Ellahi
Keyword(s):  
Type 2 Diabetes ◽  
Low Income ◽  
Health Care Systems ◽  
Early Years ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Middle Income ◽  
Sugary Drinks ◽  
Sub Saharan

This review aims to explore trends of early consumption of sugar-sweetened beverages (SSB) in sub-Saharan Africa (SSA), within the context of growing child and adolescent obesity and escalating type-2 diabetes prevalence. We explore efforts to mitigate these, drawing on examples from Africa and elsewhere. SSB, including carbonated drinks and fruit juices, play a contributory role in the development of obesity and associated non-communicable diseases (NCD). SSA is an attractive market for beverage companies owing to its rapid economic growth, growing middle class and youthful populations. SSB already contribute significantly to total sugar and energy consumption in SSA where a plethora of marketing techniques targeted at younger people are utilised to ensure brand recognition and influence purchasing and brand loyalty. Coupled with a general lack of nutrition knowledge or engagement with preventative health, this can lead to frequent consumption of sugary drinks at a young age. Public health efforts in many high income and some middle-income countries address increasing prevalence of obesity and type-2 diabetes by focusing on strategies to encourage reduction in sugar consumption via health policy and public education campaigns. However, similar efforts are not as developed or forthcoming in low-income countries. Health care systems across SSA are ill-prepared to cope with epidemic proportions of NCD, particularly when contextualised with the ongoing battle with infectious diseases. We conclude that greater efforts by governments and the nutrition community to educate the public on the health effects of increased and excessive consumption of SSB are necessary to help address this issue.

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