scholarly journals Lung function and atherosclerosis: a cross-sectional study of multimorbidity in rural Uganda

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Rebecca F. Gilbert ◽  
Cody Cichowitz ◽  
Prossy Bibangambah ◽  
June-Ho Kim ◽  
Linda C. Hemphill ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Socioeconomic Status ◽  
Lung Function ◽  
High Income ◽  
Sub Saharan Africa ◽  
Smoking History ◽  
Hiv Serostatus ◽  
Sub Saharan ◽  
The Relationship

Abstract Background Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure. Methods We measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status. Results Of 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT. Conclusions Impaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.

scholarly journals HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leonard E. Egede ◽  
Rebekah J. Walker ◽  
Patricia Monroe ◽  
Joni S. Williams ◽  
Jennifer A. Campbell ◽  
...  
Keyword(s):  
South Africa ◽  
Cardiovascular Disease ◽  
Health Survey ◽  
Survey Design ◽  
Logistic Models ◽  
Population Data ◽  
Demographic And Health Survey ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
The Relationship

Abstract Background Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey. Methods Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population. Results Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa. Discussion HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV. Conclusions The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

Cardiovascular disease: the new epidemic in sub-Saharan Africa

Vascular ◽  
2011 ◽  
Vol 19 (6) ◽  
pp. 301-307 ◽  
Author(s):  
Ifechukwude Ikem ◽  
Bauer E Sumpio
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Sub Saharan Africa ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Double Burden ◽  
The Usa ◽  
Acquired Immunodeficiency ◽  
Sub Saharan ◽  
Immunodeficiency Syndrome

Sub-Saharan Africa (SSA) is now facing a double burden of disease where patients are suffering from non-communicable diseases such as coronary heart disease, along with the burden of the current human immunodeficiency virus (HIV) epidemic. Due to this double burden, cardiovascular disease (CVD) prevention and treatment has been overlooked, allowing the rates to continue to rise unchecked. A series of searches were conducted using PubMed as the primary database. From these searches, journal articles were compiled that related to diabetes, obesity and smoking rates in SSA. Also, the prevalence of CVD in the USA was reviewed. Although the USA has higher rates of CVD now, the rates were on the decline compared with SSA. Due to ‘Westernization’ of SSA, the rates of CVD risk factors, such as diabetes, are expected to increase by 50%. Because of this, 80% of CVD deaths worldwide took place in developing countries like those in SSA. Although HIV/acquired immunodeficiency syndrome (AIDS) is the current epidemic in SSA, CVD disease poses a threat as the new epidemic because of the increasing rates of these CVD risk factors. Without combating this disease now, SSA is facing an epidemiological shift from AIDS to CVD being the leading cause of death.

scholarly journals Sanitary inspection, microbial water quality analysis, and water safety in handpumps in rural sub-Saharan Africa

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Emma Kelly ◽  
Ryan Cronk ◽  
Michael Fisher ◽  
Jamie Bartram
Keyword(s):  
Risk Factors ◽  
Water Quality ◽  
Alternative Model ◽  
Model Fit ◽  
Sub Saharan Africa ◽  
Quality Analysis ◽  
Water Quality Analysis ◽  
E Coli ◽  
Sub Saharan ◽  
The Relationship

AbstractIn sub-Saharan Africa, over half of the population is exposed to contaminated drinking water. The WHO recommends both sanitary inspection and water quality analysis to assess the risk of water source contamination, but the relationship between these tools is poorly understood. We explore the relationship between sanitary inspection and water quality analysis using data from 1028 boreholes with handpumps in 12 countries in sub-Saharan Africa. Sanitary inspection scores and E. coli occurrence were compared using the models described in published literature, and an alternative model that better reflects causal pathways of contamination. In the alternative model, sanitary risk factors were categorized as contamination sources, carriers, or barrier breakdowns, and the relationships between risk factor combinations and E. coli occurrence were assessed. We found no associations between sanitary risk score and E. coli occurrence using either the established or alternative model. These results confirm that sanitary inspections and microbial analyses convey distinct information, and perfect correlation is neither expected nor desired. The alternative model demonstrated a slightly better model fit than most established models, and the model fit further improved when the occurrence of rainfall in the past two days was added as a carrier. We recommend that: implementers train water system operators to conduct sanitary inspection; and researchers work to improve our understanding of the effect of individual sanitary risk factors, as well as incorporate contextual data into their assessments of sanitary inspection and water quality.

scholarly journals Associations between low HDL, sex and cardiovascular risk markers are substantially different in sub-Saharan Africa and the UK: analysis of four population studies

2021 ◽  
Vol 6 (5) ◽  
pp. e005222
Author(s):  
Rosamund Greiner ◽  
Moffat Nyrienda ◽  
Lauren Rodgers ◽  
Gershim Asiki ◽  
Louis Banda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Geometric Mean ◽  
Hdl Cholesterol ◽  
Sub Saharan Africa ◽  
Low Hdl ◽  
Sub Saharan ◽  
The Uk ◽  
The Relationship

IntroductionLow high-density lipoprotein (HDL) is widely used as a marker of cardiovascular disease risk, although this relationship is not causal and is likely mediated through associations with other risk factors. Low HDL is extremely common in sub-Saharan African populations, and this has often been interpreted to indicate that these populations will have increased cardiovascular risk. We aimed to determine whether the association between HDL and other cardiovascular risk factors differed between populations in sub-Saharan Africa and the UK.MethodsWe compared data from adults living in Uganda and Malawi (n=26 216) and in the UK (n=8747). We examined unadjusted and adjusted levels of HDL and applied the WHO recommended cut-offs for prevalence estimates. We used spline and linear regression to assess the relationship between HDL and other cardiovascular risk factors.ResultsHDL was substantially lower in the African than in the European studies (geometric mean 0.9–1.2 mmol/L vs 1.3–1.8 mmol/L), with African prevalence of low HDL as high as 77%. Total cholesterol was also substantially lower (geometric mean 3.3–3.9 mmol/L vs 4.6–5.4 mmol/L). In comparison with European studies the relationship between HDL and adiposity (body mass index, waist to hip ratio) was greatly attenuated in African studies and the relationship with non-HDL cholesterol reversed: in African studies low HDL was associated with lower non-HDL cholesterol. The association between sex and HDL was also different; using the WHO sex-specific definitions, low HDL was substantially more common among women (69%–77%) than men (41%–59%) in Uganda/Malawi.ConclusionThe relationship between HDL and sex, adiposity and non-HDL cholesterol in sub-Saharan Africa is different from European populations. In sub-Saharan Africans low HDL is a marker of low overall cholesterol and sex differences are markedly attenuated. Therefore low HDL in isolation is unlikely to indicate raised cardiovascular risk and the WHO sex-based cut-offs are inappropriate.

scholarly journals Smoking and HIV in Sub-Saharan Africa: A 25-Country Analysis of the Demographic Health Surveys

2018 ◽  
Vol 21 (8) ◽  
pp. 1093-1102 ◽  
Author(s):  
John D Murphy ◽  
Benmei Liu ◽  
Mark Parascandola
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Logistic Regression ◽  
Health Surveys ◽  
Smoking Prevalence ◽  
Sub Saharan Africa ◽  
Hiv Status ◽  
Multivariate Logistic Regression ◽  
Sub Saharan ◽  
Hiv Aids

Abstract Background Having HIV/AIDS has been associated with a higher prevalence of smoking. Moreover, evidence suggests that people with HIV/AIDS who smoke have poorer treatment and survival outcomes. The HIV–smoking relationship is understudied in sub-Saharan Africa, where tobacco use patterns and HIV prevalence differ greatly from other world regions. Methods Cross-sectional data from the Demographic Health Surveys and AIDS Indicator Surveys, representing 25 sub-Saharan African countries, were pooled for analysis (n = 286850). The association between cigarette smoking and HIV status was analyzed through hierarchical logistic regression models. This study also examined the relationship between smokeless tobacco (SLT) use and HIV status. Results Smoking prevalence was significantly higher among men who had HIV/AIDS than among men who did not (25.90% vs 16.09%; p < .0001), as was smoking prevalence among women who had HIV/AIDS compared with women who did not (1.15% vs 0.73%; p < .001). Multivariate logistic regression revealed that the odds of smoking among people who had HIV/AIDS was 1.12 times greater than among people who did not when adjusting for socioeconomic, demographic, and sexual risk factors (adjusted OR = 1.12, 95% CI = 1.04% to 1.21%; p < .001). Similarly, multivariate logistic regression revealed that HIV-positive individuals were 34% more likely to use SLT than HIV-negative individuals (adjusted OR = 1.34, 95% CI = 1.17% to 1.53%). Conclusion Having HIV was associated with a greater likelihood of smoking cigarettes as well as with using SLT in sub-Saharan Africa. These tobacco use modalities were also associated with male sex and lower socioeconomic status. Implications This study shows that in sub-Saharan Africa, as in more studied world regions, having HIV/AIDS is associated with a higher likelihood of smoking cigarettes when adjusting for demographic, socioeconomic, and sexual risk factors. This study also supports the literature stating that cigarette smoking is inversely associated with socioeconomic status, as evidenced by higher smoking prevalence among poorer individuals, less educated individuals, and manual and agricultural laborers.

The Relationship between Immigration Status and Cardiovascular Disease Risk Factors in United States Adults with Diabetes—A 14-Year Study

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1491-P
Author(s):  
APRILL DAWSON ◽  
EMMA GARACCI ◽  
MUKOSO N. OZIEH ◽  
REBEKAH J. WALKER ◽  
LEONARD E. EGEDE
Keyword(s):  
United States ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cardiovascular Disease Risk Factors ◽  
Immigration Status ◽  
The Relationship

scholarly journals Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hafte Kahsay Kebede ◽  
Lillian Mwanri ◽  
Paul Ward ◽  
Hailay Abrha Gesesew
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Care Services ◽  
Validity Assessment ◽  
Sub Saharan ◽  
Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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