Acute Coronary Syndrome in Patient with Viral Hepatitis C: An Underdiagnosed Condition in Sub-Saharan Africa

Abstract Background The incidence of acute coronary syndrome (ACS) is growing across sub-Saharan Africa and many healthcare systems are ill-equipped for this growing burden. Evidence suggests that healthcare providers may be underdiagnosing and undertreating ACS, leading to poor health outcomes. The goal of this study was to examine provider perspectives on barriers to ACS care in Tanzania in order to identify opportunities for interventions to improve care. Methods Semistructured in-depth interviews were conducted with physicians and clinical officers from emergency departments and outpatient departments in northern Tanzania. Thematic analysis was conducted using an iterative cycle of coding and consensus building. Results The 11 participants included six physicians and five clinical officers from health centers, community hospitals and one referral hospital. Providers identified barriers related to providers, systems and patients. Provider-related barriers included inadequate training regarding ACS and poor application of textbook-based knowledge. System-related barriers included lack of diagnostic equipment, unavailability of treatments, referral system delays, lack of data regarding disease burden, absence of locally relevant guidelines and cost of care. Patient-related barriers included inadequate ACS knowledge, inappropriate healthcare-seeking behavior and non-adherence. Conclusions This study identified actionable barriers to ACS care in northern Tanzania. Multifaceted interventions are urgently needed to improve care.

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Acute Coronary Syndromes in Sub‐Saharan Africa: A 10‐Year Systematic Review

Journal of the American Heart Association ◽

10.1161/jaha.120.021107 ◽

2021 ◽

Author(s):

Hermann Yao ◽

Arnaud Ekou ◽

Thierry Niamkey ◽

Sandra Hounhoui Gan ◽

Isabelle Kouamé ◽

...

Keyword(s):

South Africa ◽

Systematic Review ◽

Acute Coronary Syndrome ◽

Cote D'ivoire ◽

Côte D’Ivoire ◽

Sub Saharan Africa ◽

Cote D’Ivoire ◽

Coronary Syndrome ◽

Côte D'ivoire ◽

Sub Saharan

Background Data in the literature on acute coronary syndrome in sub‐Saharan Africa are scarce. Methods and Results We conducted a systematic review of the MEDLINE (PubMed) database of observational studies of acute coronary syndrome in sub‐Saharan Africa from January 1, 2010 to June 30, 2020. Acute coronary syndrome was defined according to current definitions. Abstracts and then the full texts of the selected articles were independently screened by 2 blinded investigators. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses standards. We identified 784 articles with our research strategy, and 27 were taken into account for the final analysis. Ten studies report a prevalence of acute coronary syndrome among patients admitted for cardiovascular disease ranging from 0.21% to 22.3%. Patients were younger, with a minimum age of 52 years in South Africa and Djibouti. There was a significant male predominance. Hypertension was the main risk factor (50%–55% of cases). Time to admission tended to be long, with the longest times in Tanzania (6.6 days) and Burkina Faso (4.3 days). Very few patients were admitted by medicalized transport, particularly in Côte d'Ivoire (only 34% including 8% by emergency medical service). The clinical presentation is dominated by ST–elevation sudden cardiac arrest. Percutaneous coronary intervention is not widely available but was performed in South Africa, Kenya, Côte d'Ivoire, Sudan, and Mauritania. Fibrinolysis was the most accessible means of revascularization, with streptokinase as the molecule of choice. Hospital mortality was highly variable between 1.2% and 24.5% depending on the study populations and the revascularization procedures performed. Mortality at follow‐up varied from 7.8% to 43.3%. Some studies identified factors predictive of mortality. Conclusions The significant disparities in our results underscore the need for a multicenter registry for acute coronary syndrome in sub‐Saharan Africa in order to develop consensus‐based strategies, propose and evaluate tailored interventions, and identify prognostic factors.

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Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa

CardioVascular Journal of Africa ◽

10.5830/cvja-2018-066 ◽

2019 ◽

Vol 30 (1) ◽

pp. 29-33 ◽

Cited By ~ 1

Author(s):

Mohamed Hasham Varwani ◽

Mohamed Jeilan ◽

Mzee Ngunga ◽

Anders Barasa

Keyword(s):

Acute Coronary Syndrome ◽

Referral Hospital ◽

Sub Saharan Africa ◽

Coronary Syndrome ◽

Sub Saharan

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A novel variant of genotype 7b hepatitis C virus emphasizing viral hepatitis elimination challenges for sub-Saharan Africa

Pan African Medical Journal ◽

10.11604/pamj.2020.36.232.24726 ◽

2020 ◽

Vol 36 ◽

Author(s):

Mark Wayne Sonderup ◽

Heidi Smuts ◽

Catherine Wendy Spearman

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Viral Hepatitis ◽

Sub Saharan Africa ◽

Novel Variant ◽

Sub Saharan

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HIV and viral hepatitis co-infection in pregnancy: an epidemiological, clinical and diagnostic review

Brazilian Journal of Biological Sciences ◽

10.21472/bjbs.040813 ◽

2017 ◽

Vol 4 (8) ◽

pp. 345-354

Author(s):

Sávio Freire da Silva ◽

Roseane Mara Cardoso Lima Verde ◽

José Felipe Pinheiro do Nascimento Vieira ◽

Leonardo Ferreira Soares ◽

Matheus Hipólito do Nascimento ◽

...

Keyword(s):

Hepatitis C ◽

Hepatitis B ◽

Viral Hepatitis ◽

Vertical Transmission ◽

Health Professionals ◽

The United States ◽

Sub Saharan Africa ◽

Chronic Complications ◽

Increased Risk ◽

Sub Saharan

Even though the survival of the population infected with HIV has been increased due to the intensification of antiretroviral therapy, co-infection with hepatitis B or hepatitis C has attracted the attention of doctors and other health professionals regarding the increased incidence of chronic complications resulting from viral hepatitis in HIV-infected population, which differs from that with other opportunistic diseases. Women coinfected with these viruses have an increased risk of complications during pregnancy, and the vertical transmission of these infections cause significant morbidity and mortality among children. This study aimed to investigate the risks of co-infection with HIV, hepatitis B, and hepatitis C during pregnancy, through a literature review of the last ten years, using the databases LILACS, MEDLINE and SCIELO, which make up the Virtual Health Library. A total of 106 articles were found, by searching in these databases, 46 of which were pre-selected to be read in full, resulting in 15 approved articles. It was noted that most of the accepted studies were carried out in countries of sub-Saharan Africa and Europe, followed by Brazil and the United States. The presence of co-infections made the infection worse and led to disease progression, both in the mother and in the child, compared to infection with only one of these viruses. Therefore, early diagnosis and prevention and treatment are essential to reduce and prevent the vertical transmission of these viruses.

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Effect of a Triage‐Based Screening Protocol on Diagnosis and Treatment of Acute Coronary Syndrome in a Tanzanian Emergency Department: A Prospective Pre‐Post Study

Journal of the American Heart Association ◽

10.1161/jaha.120.016501 ◽

2020 ◽

Vol 9 (16) ◽

Author(s):

Julian T. Hertz ◽

Francis M. Sakita ◽

Godfrey L. Kweka ◽

Gerald S. Bloomfield ◽

John A. Bartlett ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Troponin I ◽

Point Of Care ◽

Sub Saharan Africa ◽

Shortness Of Breath ◽

Coronary Syndrome ◽

Screening Protocol ◽

Sub Saharan ◽

Research Assistants

Background Evidence suggests that acute coronary syndrome (ACS) is underdiagnosed in sub‐Saharan Africa. Triage‐based interventions have improved ACS diagnosis and management in high‐income settings but have not been evaluated in sub‐Saharan African emergency departments (EDs). Our objective was to estimate the effect of a triage‐based screening protocol on ACS diagnosis and care in a Tanzanian ED. Methods and Results All adults presenting to a Tanzanian ED with chest pain or shortness of breath were prospectively enrolled. Treatments and clinician‐documented diagnoses were observed and recorded. In the preintervention phase (August 2018 through January 2019), ACS testing and treatment were dictated by physician discretion, as per usual care. A triage‐based protocol was then introduced, and in the postintervention phase (January 2019 through October 2019), research assistants performed ECG and point‐of‐care troponin I testing on all patients with chest pain or shortness of breath upon ED arrival. Pre‐post analyses compared ACS care between phases. Of 1020 total participants (339 preintervention phase, 681 postintervention phase), mean (SD) age was 58.9 (19.4) years. Six (1.8%) preintervention participants were diagnosed with ACS, versus 83 (12.2%) postintervention participants (odds ratio [OR], 7.51; 95% CI, 3.52–19.7; P <0.001). Among all participants, 3 (0.9%) preintervention participants received aspirin, compared with 50 (7.3%) postintervention participants (OR, 8.45; 95% CI, 3.07–36.13; P <0.001). Conclusions Introduction of a triage‐based ACS screening protocol in a Tanzanian ED was associated with significant increases in ACS diagnoses and aspirin administration. Additional research is needed to determine the effect of ED‐based interventions on ACS care and clinical end points in sub‐Saharan Africa.

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