Abstract 233: Diagnostic and Treatment Capacity for Heart Failure in Sub-Saharan Africa: an Analysis of Uganda and Kenya

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Selma Durakovic ◽  
Herbert Duber ◽  
Gregory Roth
Keyword(s):  
Heart Failure ◽  
Inpatient Care ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Survey Question ◽  
Hiv Counseling ◽  
Reduced Ejection Fraction ◽  
Treat Heart Failure ◽  
Nationally Representative ◽  
Sub Saharan

Background: There is increasing recognition that heart failure is a significant component of disease burden in Sub-Saharan Africa (SSA) and that better strategies for heart failure management are needed. However, relatively little is known about the capacity to diagnose and treat heart failure in this region. Objectives: In this study, we seek to better understand the health system’s capacity to diagnose and treat heart failure in Uganda and Kenya, in order to inform policy planning and interventions. Methods: We analyzed data from a nationally-representative survey of health facilities in Uganda and Kenya, conducted by the Institute for Health Metrics and Evaluation (IHME) as part of the Access, Bottlenecks, Costs, and Equity (ABCE) project. A structured survey instrument was administered at each facility between 2011 and 2012. In this study we examine the availability of cardiac diagnostic technologies, medications for heart failure, and emergency transportation to an inpatient facility. A package of medications for heart failure with reduced ejection fraction (HFrEF) was defined from local formulary guidelines as including beta-blocker (propranolol or atenolol), ACE inhibitor (captopril or lisinopril), and furosemide. Facility-level data was analyzed by platform type (hospital vs health center), ownership (public vs private), inpatient care availability, and location (urban, semi-urban, or rural). Results: We analyzed 197 health facilities in Uganda and 143 in Kenya after excluding dispensaries, pharmacies, and HIV counseling centers. Among facilities responding to this survey question, functional and staffed ECG was available in 24% of facilitiesin Uganda and 36% of facilities in Kenya. However, this survey question was left unanswered by approximately 70% of the facilities in each country. In regards to treatment capabilities, 37% of Ugandan and 24% of Kenyan facilities reported availability of a basic package of heart failure medications on the day the survey was administered. This was driven predominantly by the low availability of ACE inhibitors, which were available in only 41% of Ugandan and 29% of Kenyan facilities. Of the facilities with medication availability, 26% of Ugandan and 32% of Kenyan facilities had a significant stock out (8+ days) of at least one of the medications in the prior quarter. Of the facilities that did not offer inpatient care, 41% of Ugandan and 66% of Kenyan facilities were prepared for emergency transportation. Conclusion: Few facilities in Uganda and Kenya were prepared to perform necessary tests to diagnose and manage heart failure. Less than half of the facilities in both countries had the medications needed to treat HFrEF. Further investment in cardiac care will be required by these developing health systems if they are to address the growing burden of heart failure.

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.

HIV Counseling and Testing of Pregnant Women in Sub-Saharan Africa

2001 ◽  
Vol 28 (5) ◽  
pp. 458-462
Author(s):  
Charles Kilewo ◽  
Augustine Massawe ◽  
Eligius Lyamuya ◽  
Innocent Semali ◽  
Festus Kalokola ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Sub Saharan Africa ◽  
Hiv Counseling And Testing ◽  
Hiv Counseling ◽  
Counseling And Testing ◽  
Sub Saharan

Abstract 65: Anemia-related Heart Failure in Sub-saharan African Sickle Cell Disease Patients

2017 ◽  
Vol 121 (suppl_1) ◽  
Author(s):  
Adebayo C Atanda ◽  
Yahya Aliyu ◽  
Oluwafunmilayo Atanda ◽  
Aliyu Babadoko ◽  
Aisha Suleiman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Hemoglobin Level ◽  
Sub Saharan Africa ◽  
Cell Disease ◽  
Jet Velocity ◽  
Sub Saharan

Introduction: Anemia has been implicated in heart failure. Existing literatures, involving predominantly African-Americans, suggests that Sickle Cell Disease (SCD) maybe linked to various cardiovascular complications including pulmonary hypertension and left venticular dysfunction. Peculiarly, our study involves exclusively Sub-Saharan population. Method: We conducted a cross sectional observational study of 208 hydroxyurea-naive consecutive SCD patients aged 10-52 years at steady state and 94 healthy non-matched controls who were studied in an out patient clinic in Sub-Saharan Africa. SCD patients were required to have electrophoretic or liquid chromatography documentation of major sickling phenotypes. Control group was required to have non-sickling phenotypes. Cardiac measurements were performed with TransThoracic Echo according to American Society of Echocardiography guidelines. Hemoglobin level was also obtained. Results: Hemoglobin level in SCD group (8.5+/- 1.5) was significant (P<0.001) compared to control (13.8+/- 1.7). Although SCD group had significantly higher values of left ventricular (LV) size, there was no qualitative evidence of LV dysfunction. SCD group had higher values of Ejection Fraction but not statistically significant. There was no evidence of LV wall stiffening to impair proper filling in SCD group, with the ratio of early to late ventricular filling velocities, E/A ratio elevated (1.7+/-0.4 compared to 1.6+/- 0.4; P=0.010). Right ventricular systolic pressure was determined using the formula of 4x Tricuspid Reugurgitant jet (TRV) square as an indirect measurement of Pulmonary arterial systolic pressure. SCD patients had significantly higher mean±SD values for tricuspid regurgitant jet velocity than did the controls (2.1±0.6 vs. 1.8±0.5; p= 0.001). Within the SCD group, there was no clear pattern of worsening diastolic function with increased TRV. Furthermore, E/A had a significant positive relationship with jet velocity in bivariate analysis (R=0.20; P=0.013). Conclusions: We were unable to demonstrate existence of anemia-associated left ventricular dysfunction in Sub-Saharan African with SCD. Further studies is required to highlight the reason behind this finding.

scholarly journals Heart failure in sub-Saharan Africa: A clinical approach

2015 ◽  
Vol 106 (1) ◽  
pp. 23 ◽  
Author(s):  
Sarah Kraus ◽  
Gboyega Ogunbanjo ◽  
Karen Sliwa ◽  
Ntobeko A B Ntusi
Keyword(s):  
Heart Failure ◽  
Sub Saharan Africa ◽  
Clinical Approach ◽  
Sub Saharan

scholarly journals Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa

PLoS ONE ◽  
2018 ◽  
Vol 13 (6) ◽  
pp. e0198622 ◽  
Author(s):  
Mufaro Kanyangarara ◽  
Neff Walker ◽  
Ties Boerma
Keyword(s):  
Health Facilities ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Characteristics of patients with acute heart failure in North Central Nigeria

2021 ◽  
Vol 9 (3) ◽  
pp. 221-235
Author(s):  
J.A. Ogunmodede ◽  
P.M. Kolo ◽  
M.O. Bojuwoye ◽  
B.F. Dele-Ojo ◽  
A.J. Ogunmodede ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Heart Association ◽  
Public Health Education ◽  
Sub Saharan Africa ◽  
Aetiological Factor ◽  
Cross Sectional ◽  
Early Presentation ◽  
North Central ◽  
Sub Saharan

Objectives: Heart failure (HF) is an important cause of hospital admission in Nigeria. HF is increasingly prevalent because the population is aging and HF epidemiology is changing. We aimed at profiling the socio-demographic, clinical and echocardiographic (Echo)  characteristics of patients admitted for acute HF. This is one of the largest cohorts of HF patients profiled in Nigeria so far. Methods: Cross sectional design. Socio-demographic, clinical and Echo data were collected from 455 patients admitted for AHF at University of Ilorin Teaching Hospital, North central, Nigeria. Results: Mean age of patients was 58.9± 15.7years, (men were older than women, P= 0.006). 265(58.2%) were males, most patients were aged >60 years, 4.8% had pre-existing Type2 Diabetes mellitus. 53.2% of patients presented in New York Heart Association Stages III and IV. Median duration of admission was 11days (IQR, 6-17), intrahospital mortality- 11.6%. Hypertension was the commonest aetiological factor (62.4%), followed by dilated cardiomyopathy 17.6%, rheumatic heart disease (6.6%), Peripartum cardiomyopathy (5.3%), and others. Conclusion: AHF patients in our study are older than those in previous studies in Nigeria and sub-Saharan Africa. Hypertension is main driver of AHF, and patients largely present with clinically advanced disease necessitating stronger public health education about risk factors and early presentation.  

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