Neglected cardiomyopathies in Africa

Cardiomyopathies are forms of disease in which the heart muscle is structurally and functionally abnormal in the absence of coronary artery disease, hypertension, valve disease and congenital heart disease sufficient to explain the observed myocardial abnormality. They constitute the greatest challenge of all the cardiovascular diseases in Africa, due to the difficulties in diagnosing and managing them, related to the lack of access to specialised investigations or effective interventions in most endemic areas. In this continent, in addition to the “usual” forms of cardiomyopathy, there is an increased incidence of specific forms of muscle heart disease like Endomyocardial Fibrosis and Peripartum Cardiomyopathy which, despite affecting thousands of people, have been largely neglected. Their etiology remains unknown, the mechanisms involved are not fully understood, and although some improvement in management has been witnessed in recent years much still need to be done to improve the outcome. The current knowledge on epidemiology, determinants, pathophysiology, diagnosis and management of Endomyocardial Fibrosis and Peripartum Cardiomyopathy is reviewed in this article, which also presents the ongoing efforts for better understanding of their pathogenesis and the recent improvements in their management

Rheumatic heart disease and endomyocardial fibrosis: Distinguishing the etiology of mitral regurgitation in low-resourced areas

Rheumatic heart disease (RHD) and endomyocardial fibrosis (EMF) are 2 neglected cardiovascular diseases that disproportionately affect young populations, living in poverty. RHD characteristically occurs in low- and middle-income countries, as well as in some disadvantaged populations within high-income countries, such as the Aboriginal peoples of Australia. In contrast, EMF is primarily a tropical cardiomyopathy, with both high-prevalence countries and high-prevalence regions within affected countries.The etiology, pathogenesis, echocardiographic findings, interventions and prognosis are quite distinct. While RHD is unarguably the most preventable of all cardiac diseases, resulting from untreated or undertreated group A streptococcal infections, EMF’s etiology remains unclear. It has been related to infections, dietary factors and toxic agents, and currently there are no specific drugs to treat EMF.The distinction of mitral lesions due to RHD from leftsided EMF, can be difficult in endemic areas for both diseases, especially in the context of lack of resources for diagnosis. However, the correct distinction is highly important since medical management, surgical and interventional options and prognosis are considerably different. Here we describe the features that allow this distinction in African settings where both diseases occur, paying particular emphasis to echocardiography

Presence of Circulating Anti-Myosin Antibodies in Endomyocardial Fibrosis

Endomyocardial Fibrosis is a tropical disease in which the heart cannot open properly to receive blood due to a scar that covers its inner layer. It affects mainly children and adolescents, and has a poor prognosis because the cause and mechanisms of scarring are unknown. The conventional treatment is frustrating and does not alter the natural history of the disease. Despite affecting several million people worldwide there has been little investigation on the mechanisms of the disease or drug development to improve its prognosis. In this study we investigate the presence of antibodies against the myocardial cells of African patients with severe and advanced EMF aiming at uncovering new pathways for the disease. Our results reveal that EMF patients have anti-myocardial antibodies in their blood. The reaction of these antibodies with the heart may be one of the mechanisms involved in the genesis of the fibrotic lesions. This knowledge may help in diagnosing the condition and provide alternatives for its management, using drugs that reduce the impact of the circulating antibodies in the cardiac tissue. The significance of these results needs confirmation on studies involving larger number of subjects due to frequent finding of antiheart antibodies in African populations with heart failure of any cause

Advice to health professionals: Use of lignocaine as a diluent to reduce the pain associated with the administration of benzathine penicillin G

No Abstract

Epidemiology, Pathogenesis and Management of Endomyocardial Fibrosis

This thesis investigates Endomyocardial Fibrosis (EMF), the commonest form of restrictive cardiomyopathy affecting children and young adults from poor developing countries. EMF is the second cause of admission for acquired cardiovascular disease in these age groups in endemic areas and has an unclear etiology and pathogenesis. It has no specific treatment and carries a poor prognosis. The methodology followed for this investigation was the implementaion of large-scale epidemiological studies on incidence, prevalence and determinants of EMF in an endemic area of Mozambique, using echocardiography. New classification and scoring system for diagnosing and assessing EMF severity was evolved and applied in community and hospital-based studies. Concomitantly, characterization of the clinical and biological profile of EMF in its different stages was done, as well as investigation of the genetic susceptibility to the disease. Finally, new surgical procedures based on the specific pathophysiology were developed and applied, with attempts at optimizing the timing of surgery and its results. This work has established that echocardiographic screening is able to detect early and asymptomatic stages of EMF, and that it is a useful tool in assessing its progression, identifying patients that can benefit from surgery and monitoring response to treatment. It also shows that novel surgical approaches based in tailored techniques to the specific components of the disease can improve the outcome. The use of the standardized criteria in prospective studies may improve knowledge of the natural history and pathogenesis of EMF allowing better management of EMF and identication of new therapeutic targets

Impact of socioeconomic status, ethnicity, and urbanization on risk factor profiles of cardiovascular disease in Africa

Africa is a continent characterized by marked ethnic, sociodemographic, and economic diversity, with profound changes in many regions over the past 2 decades. This diversity has an impact on cardiovascular disease presentation and outcomes. Within Africa and within the individual countries, one can find regions having predominantly communicable diseases such as rheumatic heart disease, tuberculous pericarditis, or cardiomyopathy and others having a marked increase in noncommunicable disease such as hypertension and hypertensive heart disease. Ischemic heart disease remains rare in most countries. Difficulties in the planning and implementation of effective health care in most African countries are compounded by a paucity of studies and a low rate of investment in research and data acquisition. The fiduciary responsibilities of companies working in Africa should include the effective and efficient use of natural resources to promote the overall health of populations

Prevalence and associated factors of common mental disorders among internally displaced people by armed conflict in Cabo Delgado, Mozambique: a cross-sectional community-based study

BackgroundHumanitarian emergencies are a major global health challenge with the potential to have a profound impact on people’s mental and psychological health. Displacement is a traumatic event that disrupts families and affects physical and psychological health at all ages. A person may endure or witness a traumatic incident, such as being exposed to war, and, as a result, develop post-traumatic stress disorder (PTSD). There is a lack of information about post-traumatic stress disorder, depression, and anxiety disorder in low and middle-income countries in humanitarian emergency contexts such as Mozambique. This study aimed to assess the prevalence of PTSD, depression, and anxiety, and associated factors among armed conflict survivors in Cabo Delgado, north region of Mozambique in 2023.MethodsA community-based cross-sectional study was conducted between January and April 2023 among 750 participants, who were selected by convenience. A face-to-face interview used the Primary Care Post-Traumatic Stress Disorder Checklist (PC-PTSD-5) to evaluate PTSD, the Generalized Anxiety Disorder Scale (GAD-7) to evaluate anxiety and the Patient Health Questionnaire – Mozambique (PHQ-9 MZ) to evaluate depression. The association between PTSD and demographic and psychosocial characteristics was analyzed using bivariate and multivariable binary logistic regression. We used a 5% significance level.ResultsThe three mental disorders assessed were highly prevalent in our sample with 74.3% PTSD, 63.8% depression, and 40.0% anxiety. The chance of developing PTSD was higher in females (AOR = 2.30, 95% CI 1.50–3.51), in patients with depression symptoms (AOR = 8.27, 95% CI = 4.97–13.74) and anxiety symptoms (AOR = 1.45, 95% CI = 0.84–2.50).ConclusionThis study reported that the prevalence of PTSD, depression, and anxiety were high. Patients having depressive symptoms, anxiety symptoms, and being female are more at risk of developing PTSD. There is a need to integrate screening for common mental disorders in the context of humanitarian emergencies and its adapted integration of psychosocial interventions