Cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe: a literature review.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.BACKGROUND: Most European countries are ethnically and culturally diverse. Globally, cardiovascular disease (CVD) is the leading cause of death. The major risk factors for CVD have been well established. This picture holds true for all regions of the world and in different ethnic groups. However, the prevalence of CVD and related risk factors vary among ethnic groups. METHODS: This article provides a review of current understanding of the epidemiology of vascular disease, principally coronary heart disease (CHD), stroke and related risk factors among populations of Sub-Sahara African descent (henceforth, African descent) in comparison with the European populations in Europe. RESULTS: Compared with European populations, populations of African descent have an increased risk of stroke, whereas CHD is less common. They also have higher rates of hypertension and diabetes than European populations. Obesity is highly prevalent, but smoking rate is lower among African descent women. Older people of African descent have more favourable lipid profile and dietary habits than their European counterparts. Alcohol consumption is less common among populations of African descent. The rate of physical activity differs between European countries. Dutch African-Suriname men and women are less physically active than the White-Dutch whereas British African women are more physically active than women in the general population. Literature on psychosocial stress shows inconsistent results. CONCLUSION: Hypertension and diabetes are highly prevalent among African populations, which may explain their high rate of stroke in Europe. The relatively low rate of CHD may be explained by the low rates of other risk factors including a more favourable lipid profile and the low prevalence of smoking. The risk factors are changing, and on the whole, getting worse especially among African women. Cohort studies and clinical trials are therefore needed among these groups to determine the relative contribution of vascular risk factors, and to help guide the prevention efforts. There is a clear need for intervention studies among these populations in Europe

Tackling Africa's chronic disease burden: from the local to the global.

Africa faces a double burden of infectious and chronic diseases. While infectious diseases still account for at least 69% of deaths on the continent, age specific mortality rates from chronic diseases as a whole are actually higher in sub Saharan Africa than in virtually all other regions of the world, in both men and women. Over the next ten years the continent is projected to experience the largest increase in death rates from cardiovascular disease, cancer, respiratory disease and diabetes. African health systems are weak and national investments in healthcare training and service delivery continue to prioritise infectious and parasitic diseases. There is a strong consensus that Africa faces significant challenges in chronic disease research, practice and policy. This editorial reviews eight original papers submitted to a Globalization and Health special issue themed: "Africa's chronic disease burden: local and global perspectives". The papers offer new empirical evidence and comprehensive reviews on diabetes in Tanzania, sickle cell disease in Nigeria, chronic mental illness in rural Ghana, HIV/AIDS care-giving among children in Kenya and chronic disease interventions in Ghana and Cameroon. Regional and international reviews are offered on cardiovascular risk in Africa, comorbidity between infectious and chronic diseases and cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe. We discuss insights from these papers within the contexts of medical, psychological, community and policy dimensions of chronic disease. There is an urgent need for primary and secondary interventions and for African health policymakers and governments to prioritise the development and implementation of chronic disease policies. Two gaps need critical attention. The first gap concerns the need for multidisciplinary models of research to properly inform the design of interventions. The second gap concerns understanding the processes and political economies of policy making in sub Saharan Africa. The economic impact of chronic diseases for families, health systems and governments and the relationships between national policy making and international economic and political pressures have a huge impact on the risk of chronic diseases and the ability of countries to respond to them.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Factors Influencing the Effects of Large-Scale Land Acquisition on The Livelihood of Smallholder Farmers in the Pru District of Ghana

This study is undertaken to find out the factors influencing the effects of large-scale land acquisition on the livelihood of smallholder farmers in the Pru district. An important driver for large-scale land acquisition in Ghana, and the rest of Africa, is the growing global demand for biofuels and other plantations. Methodologically, mixed method approach was adopted by applying both quantitative and qualitative research designs. Quantitative data was obtained through a cross-sectional survey from smallholder farming households in the study communities of the Pru District with the help of a multi-stage sampling technique and cluster sampling technique. Qualitative data was obtained through Focus Group Discussions (FGD) from farmerbased associations in the Pru district. The Pru district in the Bono East region was purposively selected based on the reason that it isthe most affected district with activities of land grabbing in Ghana. Based on the sample frame of 2,554 households in the communities, a sample size of 346 was used for the study out of which 332 were households and 14 were investors and traditional authorities. The study revealed that household heads’ level of education, sex of household heads, household engagement in off-farm activities, total farm land owned by a household, size of land lost by households to large-scale land investors, households’ participation in decision making, and training of households for other alternative jobs significantly influence large-scale land acquisition on the livelihood of smallholder farming households. The study found out that the higher the level of education of a household head, the lesser the household suffers the adverse effects of losing their farm land to largescale land investors hence their livelihoods. It was revealed that some major factors that influenced large-scale land acquisition in the Pru district were the availability of land for the cultivation of plantations by investors, the soil fertility of the land in the district and the freedom and peace enjoyed by investors to go about their businesses and enjoying good tax exemptions in such an environment thus Pru district

Ethnic Variations in Blood Pressure and Hypertension

The objective of the study was to review published evidence on whether blood pressure levels and the prevalence of hypertension are higher or lower in South Asian adults living in the UK as compared to white populations. A systematic literature review was carried out using MEDLINE 1966-2001, EMBASE 1980-2001, and citations from references. A total of 12 studies were identified. The data showed important differences between studies in terms of age and sex of samples, definition of South Asians (Indian, Pakistani and Bangladeshi) and methods of evaluating blood pressure. Seven studies reported lower mean systolic blood pressures, while seven studies showed higher diastolic pressures in South Asian men compared to white men. In women, six of nine studies showed lower systolic blood pressures, while five reported higher diastolic pressures. For prevalence of hypertension, five of 10 studies reported higher rates in South Asian men than in white men. Two of six studies showed higher prevalence rates in South Asian women. Overall, the most representative sample and up-to-date data came from the Health Survey of England 1999. Both blood pressure and the prevalence data show important differences between South Asian subgroups, yet most studies combined them. The data also showed a geographical variation between London (comparatively high blood pressure in South Asians) and the rest of the UK (comparatively low or similar blood pressure). Bangladeshis had low blood pressure and body mass index (BMI). In other South Asian subgroups, low blood pressure and the low BMI did not always coincide. To conclude, the common perception that blood pressure in South Asians is comparatively high is unreliable - the picture is complex. Overall, blood pressures are similar but there is stark heterogeneity in the South Asian groups, with slightly higher blood pressure in Indians, slightly lower blood pressure in Pakistanis, and much lower blood pressure in Bangladeshis. Variations in study methods, body shape, size and fat, and in the mix of South Asian groups probably explain much of the inconsistency in the results

The Dilemma of Vulnerable Groups During Lockdown: Implications for Social Work Education and Practice in Ghana

The Covid-19 pandemic has created socio-economic challenges for countries globally and has touched lives in some of the world’s most remote areas. While other countries have been proactive in addressing these challenges, I fear that Ghana, and to an extent most of sub-Saharan Africa, have failed to adequately prepare for and anticipate these challenges. This reflective essay discusses the paradoxes that the pandemic and the measures used to curb it have created for two vulnerable groups: informal economy workers and women and children in abusive relationships. I introduce the essay with a reflective account of the relevance and practicality of social work education and practice in Ghana in light of the ongoing pandemic. Subsequently, I focus on the two aforementioned vulnerable groups. I present a reflective account of how the challenges that emerged from this pandemic create new opportunities for my work as a social work educator and also for practice with these groups in Ghana

Ethnic differences in current smoking and former smoking in the Netherlands and the contribution of socioeconomic factors: a cross-sectional analysis of the HELIUS study.

OBJECTIVES: Data exploring how much of the ethnic differences in smoking prevalence and former smoking are explained by socioeconomic status (SES) are lacking. We therefore assessed ethnic differences in smoking prevalence and former smoking and the contribution of both educational level and occupational-related SES to the observed ethnic differences in smoking behaviour. METHODS: Data of 22 929 participants (aged 18-70 years) from the multiethnic cross-sectional Healthy Life in an Urban Setting study in the Netherlands were analysed. Poisson regression models with a robust variance were used to estimate prevalence ratios. RESULTS: Compared with the Dutch, after adjustment for age and marital status, smoking prevalence was higher in men of Turkish (prevalence ratio 1.69, 95% CI 1.54 to 1.86), African Surinamese (1.55, 95% CI 1.41 to 1.69) and South-Asian Surinamese origin (1.53, 95% CI 1.40 to 1.68), whereas among women, smoking prevalence was higher in Turkish, similar in African Surinamese but lower in all other ethnic origin groups. All ethnic minority groups, except Ghanaians, had a significantly lower smoking cessation prevalence than the Dutch. Socioeconomic gradients in smoking (higher prevalence among those lower educated and with lower level employment) were observed in all groups except Ghanaian women (a higher prevalence was observed in the higher educated). Ethnic differences in smoking prevalence and former smoking are largely, but not completely, explained by socioeconomic factors. CONCLUSIONS: Our findings imply that antismoking policies designed to target smoking within the lower socioeconomic groups of ethnic minority populations may substantially reduce ethnic inequalities in smoking particularly among men and that certain groups may benefit from targeted smoking cessation interventions

Decolonising the Discourse on Resilience

This article presents a discursive critique of the Eurocentric paradigms of knowledge production that characterise much of the underlying logics in the age of neoliberal discourses on resilience, pointing out important areas not given sufficient attention. In particular, it highlights the limits of the modernist ontology of resilience, whereby extremely “vulnerable” African communities are encouraged “to become resilient” to climatic disruption and environmental catastrophe and to “bounce back” as rapidly as possible. The article moves the discussion forward, drawing from critical decolonial approaches, in alignment with Indigenous knowledges, to question and rethink meaningful alternative ontologies, ways of knowing and being, in adaptive governance. I argue that the recognition of the plurality of many worlds, rather than one world, highlighted through critical decolonial understandings of epistemic forms with Indigenous knowledges, can be counterposed to Western universality as an innovative ontology to decentre the world order in the problematic dominant development of resilience thinking. Keywords: resilience; decolonisation; Africa; epistemology; pluriverse; Indigeneit

The Politics of Trade Disputes in the Fourth Republic: The Case of Ghana and Nigeria

The relationship between Ghana and Nigeria over the years can be described as oscillatory because of the occasional twist and turn. Notably, a trade dispute was one of the challenges that marred the relationship between the two countries. Historically, trade disputes emerged in the 1930s as a result of the cocoa hold-up crisis in 1932, and this led to the call by the National Crusade for the protection of Ghanaian enterprises to expel foreign traders, predominantly Nigerians. This phenomenon continued during Busia's regime, where he expelled a large number of Nigerian traders through the Aliens Compliance Order in 1969. Buhari's regime also responded in 1983-85 by expelling over one million Ghanaians from Nigeria for economic and trade reasons. In 2012, the government of Ghana employed a contingent economic policy that led to the closure of many Nigerian shops. Moreover, the closure of the Nigerian land borders on Ghana and other trading partners revived the trade tension between the two countries, where Ghanaians retaliated with other draconian policies. The intermittent trade disputes between the two countries triggered the quest of the researchers to assess the fundamental driving forces of the impasse, identify the politico-economic ramifications of the disputes on both countries and provide some recommendations to deal with the problem. Relevant related literature was reviewed thematically, and International Regime Theory was used to underpin the research. The study used a qualitative research approach to gather in-depth data from respondents through interviews and observations. Thematic analysis was used as an approach for data interpretation and discussion. The relevant literature and the findings revealed that the inconsistencies of ECOWAS protocols with the national trade policies, the use of protectionist economic policies such as the "prohibited goods" policy by Nigeria against Ghana, and the implementation of the GIPC Act 2013 (865), Nigeria’s border closure, and lockdown of Nigerian retail shops in Ghana were some of the fundamental driving forces of the trade disputes between the countries in the fourth republic. Economically, the occasional trade disturbances led to the loss of capital and revenue for traders from both sides. Notwithstanding these challenges, there was an initiative by both governments to find a lasting solution to the menace. The research concluded with some recommendations for policy and praxis. Keywords: Trade Dispute, ECOWAS Protocols, Traders Association, West Africa, Fourth Republic DOI: 10.7176/JESD/14-10-07 Publication date:May 31st 202