Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast)

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire. Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009. Results. The patients mean age was 73.1 ± 5.3 years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was 169.4 ± 28.4 mmHg for systolic, 95.3 ± 15.7 mmHg for diastolic, and 74.1 ± 22.8 mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%. Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target

Level of Concordance of Pre-, Intra-, and Postoperative Staging in Cervical Cancers (TREYA Study)

Concomitant radiochemotherapy is the therapeutic standard for locally advanced (Ib2 to IVa stage FIGO) cervical cancer. In the absence of a radiotherapy in many of our Sub-Saharan African countries, surgical resection is the only therapeutic method available in hopes of achieving a definite cure. However, criteria for curative surgery are not always met due to preoperative understaging of most of our patients. In addition to socioeconomic factors, the causes for understaging are numerous. These include the lack of personnel or underqualified personnel and the absence of complete workup to assess the resectability of the tumor, but above all the lack of decision-making through multidisciplinary consultation meetings. This study makes a plea in order to provide our hospitals with qualified personnel and adequate technical platform to allow efficient management of our patients with cervical cancer

Int J Cancer

As human papillomavirus (HPV) immunisation and HPV-based cervical cancer (CC) screening programmes expand across sub-Saharan Africa, we investigated the potential impact of human immunodeficiency virus (HIV) status on high-risk (HR)-HPV distribution among women with CC in Cote d'Ivoire. From July 2018 to June 2020, paraffin-embedded CC specimens diagnosed in Abidjan, Cote d'Ivoire were systematically collected and tested for HR-HPV DNA. Type-specific HR-HPV prevalence was compared according to HIV status. Of the 170 CC specimens analysed (median age 52 years, interquartile range: [43.0-60.0]), 43 (25.3%) were from women living with HIV (WLHIV) with a median CD4 count of 526 [373-833] cells/mm(3) and 86% were on antiretroviral therapy (ART). The overall HR-HPV prevalence was 89.4% [95% CI: 84.7-94.1]. All were single HR-HPV infections with no differences according to HIV status (P = .8). Among HR-HPV-positive CC specimens, the most prevalent HR-HPV types were HPV16 (57.2%), HPV18 (19.7%), HPV45 (8.6%) and HPV35 (4.6%), with no significant differences according to HIV status. Altogether, infection with HPV16/18 accounted for 71.1% [95% CI: 55.9-86.2] of CC cases in WLHIV vs 78.9% [95% CI: 71.3-86.5] in women without HIV (P = .3). The study confirms the major role of HPV16/18 in CC in Cote d'Ivoire and should support a regional scale-up of HPV16/18 vaccination programmes regardless of HIV status. However, vaccines targeting additional HR-HPV types, including HPV45 and HPV35, could further decrease future CC incidence in Cote d'Ivoire, both for WLHIV and women without HIV

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Barriers to early diagnosis of cervical cancer: a mixed-method study in Cote d'Ivoire, West Africa

BACKGROUND: Cervical cancer, a major public health problem in many developing countries, is usually associated with a poor survival related to an advanced disease at diagnosis. In Côte d'Ivoire and other developing countries with high cervical cancer prevalence, little is known about factors associated with advanced cervical cancer stages in a context of limited access to screening services. METHODS: From May to July 2019, we conducted a cross-sectional study using a mixed, quantitative and qualitative method. Information on socio-demographic and history of the disease was extracted from a rapid case ascertainement study performed by the cancer registry of Côte d'Ivoire that enrolled all women diagnosed with cervical cancer between July 2018 and June 2019. In-depth semi-structured interviews were conducted among a subset of these women (12 women) and six healthcare providers to further capture barriers to early cervical cancer diagnosis. Factors associated with an advanced stage III, IV (according to FIGO classification) were estimated by a logistic regression model. Qualitative data were analyzed using a thematic analysis technique guided by the treatment pathway model and triangulated with quantitative data. RESULTS: In total, 95 women with cervical cancer [median age = 51 (IQR 42-59)] years, were included. Among them, 18.9% were living with HIV and only 9.5% were covered by a health insurance. The majority (71.5%) were diagnosed with advanced cervical cancer. Being HIV-uninfected (aOR = 5.4; [1.6-17.8], p = 0.006) and being uninsured (aOR = 13.1; [2.0-85.5], p = 0.007) were independently associated with advanced cervical cancer in multivariable analysis. Qualitative data raised additional factors potentially related to advanced cervical cancer stages at diagnosis, including the lack of patient information on cervical cancer by healthcare providers and inadequate national awareness and screening campaigns. CONCLUSION: In a context of challenges in access to systematic cervical cancer screening in Côte d'Ivoire, access to health insurance or integrated healthcare program appear to be key determinants of early diagnosis of cervical cancer

L’obesite abdominale dans la population generale a Bouake (Cote d’Ivoire) : Prevalence et correlation avec la pression arterielle

Objectifs: déterminer la prévalence de l'obésité abdominale dans la population générale à Bouaké et de déterminer une éventuelle association  entre elle et l’élévation des chiffres de pression artérielle.Materiel et Methodes: il s’agit d’une étude transversale descriptive et analytique qui a été menée au cours d’une séance de dépistage  systématique à Bouaké en 2017 chez des adultes. Elle a concerné 303 adultes âgés de 18 ans et plus. Des mesures de pression artérielle et du périmètre abdominal ont été prises avec remplissage d’un questionnaire standardisé. L’obésité abdominale (OA) est définie par un périmètre abdominal (PO) ≥ 102 cm chez l’homme et ≥ 88cm chez la femme. L’analyse statistique de nos données repose sur le test de Chi2 de Pearson etl’analyse de variance pour juger de la signification ou non des différences constatées (seuil de signification retenue, p<0,05). Enfin, en vue de vérifierl’existence d’une relation entre le PO et le niveau de pression artérielle, nous avons effectué une régression linéaire avec calcul du coefficient de  corrélation r.Resultants: L’âge moyen était de 45,86±15,84ans. On notait une prédominance féminine avec un sex-ratio de 0,77. La prévalence globale de l'OAétait de 34% (hommes : 3,65%, femmes : 30,56%). Chez les hommes avec une OA, la pression artérielle systolique moyenne était significativement plus importante que chez ceux indemnes d’obésité (150,92±25,05mmHg versus 131,65±23,26 mmHg ; p=0,010). On notait les mêmes observations avec la pression artérielle diastolique (100,58±17,81 mmHg versus 80,96±14,64 mmHg ; p=0,000). Chez les femmes avec une obésité abdominale, la pression artérielle systolique moyenne était significativement plus importante que chez celles indemnes d’obésité (139,75±24,96 vs 123.59±20,42 mmHg; p=0,000). On notait les mêmes observations avec la pression artérielle diastolique (87,17±14,59 vs 76,16±11,88 mmHg; p˂0,000). Sur la corrélation entre les modifications du périmètre abdominal et les pressions artérielles : celle systolique était positive et significative chez les hommes (r= 0,4474 ; p=0,0000) ; de même que celle diastolique (r=0,4496 ; p=0,0000). Cette même observation a été faite chez les femmes avec les pressions artérielles systolique (0,3522 ; p=0,0000) et diastolique (r= 0,3411 ; p=0,0000).Conclusion: l’obésité abdominale est très fréquente dans cette population noire africaine du centre de la Côte d’Ivoire. Elle est significativement associée à une élévation du niveau de pression artérielle dans les deux sexes. Mots-clés : Obésité abdominale - population générale - Bouaké - pression artérielle   English title: Abdominal obesity in the general population in Bouake (Ivory Coast): Prevalence and correlation with arterial pressure Objectives: to determine the prevalence of abdominal obesity in the general population in Bouake and to determine a possible association between it and the high blood pressure. Materials and Methods: this is a descriptive and analytical crosssectional study that was conducted during a systematic screening session inBouake in 2018 among adults. It involved 303 adults aged 18 and over. Blood pressure and abdominal perimeter measurements were taken with completion of a standardized questionnaire. Abdominal obesity (AO) is defined by an abdominal perimeter (AP) ≥ 102 cm in men and ≥ 88 cm in women. The statistical analysis of our data is based on the Pearson Chi square test and analysis of variance to determine the significance or not of the differences found (significance threshold, p <0.05). Finally, in order to verify the existence of a relation between the AP and the blood pressure level, we performed a linear regression with the calculation of the correlation coefficient r. Results: The mean age was 45.86 ± 15.84 years. There was a female predominance with a sex ratio of 0.77. The overall prevalence of AO was 34% (men: 3.65%, women: 30.56%). In men with AO, mean systolic blood pressure was significantly higher than in those without obesity (150.92 ± 25.05 mmHg versus 131.65 ± 23.26 mmHg, p = 0.010). The same observations were observed with diastolic blood pressure (100.58 ± 17.81mmHg versus 80.96 ± 14.64 mmHg, p = 0.000). In women with abdominal obesity, mean systolic blood pressure was significantly higher than in those without obesity (139.75 ± 24.96 mmHg versus. 123.59 ± 20.42 mmHg, p = 0.000). The same observations were made with diastolic blood pressure (87.17 ± 14.59mmHg versus 76.16 ± 11.88 mmHg, p˂0.000). On the correlation between changes in the abdominal perimeter and blood pressure: systolic pressure was positive and significant in men (r = 0.4474, p = 0.0000); as was diastolic (r = 0.4496, p = 0.0000). This same observation was made in women with systolic (0.3522, p = 0.0000) and diastolic (r = 0.3411, p = 0.0000) blood pressure. Conclusion: Abdominal obesity is very common in this African black population of central Côte d'Ivoire. It is significantly associated with increased blood pressure in both sexes. Keywords: Abdominal obesity - general population – Bouake - Ivory Coast - blood pressur

Int J Gynaecol Obstet

To assess the impact of HIV on access to invasive cervical cancer (ICC) care and overall survival (OS) in a time of universal access to antiretroviral therapy (ART). A cohort of women prospectively diagnosed with ICC was consecutively recruited from 2018 to 2020 in public/private cancer centers in Côte d'Ivoire. Follow-up data were collected through facility- and phone-based approaches. Logistic and Cox regression models allowed analysis of factors associated with access to cancer care and OS, respectively. Overall, 294 women with ICC aged 50 years (interquartile range [IQR] 43-60) were enrolled, including 21.4% of women living with HIV (WLHIV), 87% being on ART. An advanced ICC clinical stage (III-IV) was less frequent in WLHIV (63.5% vs. 77.1% in HIV-uninfected women; P = 0.029). Cancer care was initiated in 124 (42.2%) women (54.0% in WLHIV; 39.0% in HIV-uninfected; P = 0.030). Factors independently associated with access to cancer care were International Federation of Gynecology and Obstetrics (FIGO) stage I-II (adjusted odds ratio [aOR] 3.58, 95% CI 2.01-6.38) and no treatment by traditional healers prior to ICC diagnosis (aOR 3.69, 95% CI 1.96-6.96). The 2-year OS was 37.9% (95% CI 30.0-47.9). HIV status was not predictive of mortality (adjusted hazard ratio [aHR] 0.98, 95% CI 0.60-1.69). An advanced clinical stage was the only measured predictor of death (aHR 1.59, 95% CI 1.02-2.47). In a time of universal access to ART, HIV infection was not associated with OS among women with ICC in Côte d'Ivoire. Higher access to cancer care in WLHIV might be mediated by enhanced access to ICC screening services, supporting the need to expand these services to other types of healthcare facilities