Cardiovascular disease and metabolic syndrome in health transition and evidence-based medicine: a perspective from Africa

The Cardiovascular Disease (CVD) pandemic worldwide presents a true challenge today with a high health burden that is only expected to rise. I address the causes and prevention of CVD, as well as CVD rehabilitation and physiology. As a member of the American Heart Association and European Society of cardiology, I practice under the level of evidence and the strength of recommendation of particular treatment options, as outlined in the tables below

Causes of visual disability among Central Africans with diabetes mellitus

Background: Diabetic Retinopathy (DR) remains a common and one of the major causes of blindness in the developed and western societies. The same situation is shown in emerging economic areas (5,6). In sub-Saharan Africa (SSA) however, the issues of visual disability due to diabetes mellitus (DM) are overshadowed by the presence of the prevalent and common nutritional deficiency diseases and eye infectionsObjective: This clinic-based study was conducted to determine whether diabetic retinopathy is independently related to visual disability in black patients with diabetes mellitus (DM) from Kinshasa, Congo.Methods: A total of 299 urban patients with DM and low income including 108 cases of visual disability and matched for time admission and DM type to 191 controls, were assessed. Demographic, clinical, and ophthalmic data were assessed using univariate and multivariate analyses.Results: Age >60 years, female sex, presence of diabetic retinopathy (DR), proliferative DR, shorter DM duration, glaucoma, macular oedema, diabetic nephropathy were the univariate risk factors of visual disability. Using logistic regression model, visual disability was significantly associated with female sex and diabetic retinopathy.Conclusion: The risk of visual disability is 4 times higher in patients with diabetic retinopathy and 2 times higher in females with DM. Therefore, to prevent further increase of visual disability, the Congolese Ministry of Health should prioritize the eye care in patients with DM.Keywords: Visual disability, diabetic retinopathy, females, risk factors, Central Afric

Impacts of supplemental irrigation as a climate change adaptation strategy for maize production: a case of the Eastern Cape Province of South Africa

Dry spells and climatic hazards are responsible for maize output decline, sometimes to levels below potential yield levels. There is a pressing need to reduce the gap between actual and potential maize yield/ha, especially among farmers in semi-arid regions. This present study examines the potential role of supplemental irrigation and its differential impact on maize yield in the Eastern Cape Province of South Africa. In this study, maize yield data were generated from information recorded over a period of 20 years by farmers in Ntabankulu through cross-sectional interviews with 124 randomly-selected farming households. Maize yields for interviewed farmers were analysed for each of the experienced climatic hazards, for yield decline per ha and preferable adaptation strategies. Maize yield analyses show a maximum ceiling/attainable yield of 0.234 t/ha and average farm yield of 0.146 t/ha. Floods or hailstorms cause 75% decline in maize yield/ha and there was no significant difference between farmers practising irrigation and those practising dryland farming (P > 0.05). Low/no rains throughout the season; delay or low onset of rainfall and a rain-break for a week or more in a season results in 75%; 54% and 50.5% decline in maize yield/ha, respectively. On a scale of 1 to 10, farmers highly rank practicing supplementary irrigation (8.4) and change of planting date (7.8) as important adaptation strategies. Rescheduling planting date from the traditional planting times to earlier or later planting dates, assisted by use of weather reports and forecasting, to some extent curbs the impact of delays or slow onset of rainfall on yield. Supplemental irrigation is instrumental in reducing the impact of mid-season drought (rains break for a week) and light rainfall throughout the season. Analyses of actual yields and yield decline against each of the experienced climatic hazards provided insight into management possibilities to stabilize maize output.Keywords: agronomic practices, climatic hazards, supplemental irrigation, semi-arid area

Glycosylated haemoglobin is markedly elevated in new and known diabetes patients with hyperglycaemic ketoacidosis

Background: Glycosylated haemoglobin (HbA1c) and random blood glucose are markers of chronic and acute hyperglycaemia respectively.Objective: We compared HbA1c levels in ketoacidosis (DKA) occurring in known and newly diagnosed diabetes.Methods: Retrospective review of medical records for 83 DKA admissions in 2008 and 2009 with results for HbA1c at presentationResults: There were 52 and 31 DKA admissions in known and newly diagnosed diabetes patients respectively. Fifty of the 83 DKA admissions were in females. The mean age (per admissions) and HbA1c of all admissions are 43.4 ± 20.3 years (n=83) and 12.7 ± 3.4 % (n=83) respectively. Mean HbA1c in known Type 1, known Type 2 and newly diagnosed diabetes patients were similarly very high: 12.4 ± 3.3 %, 12.5 ± 3.3 %, 13.1 ± 3.7 %; P = 0.6828. The HbA1c levels in newly diagnosed diabetes patients less than 30 years (likely Type 1 diabetes) and ≥ 30 years (likely Type 2 diabetes) were similar. There was a tendency to significantly positive correlation between blood glucose and HbA1c in new diabetes patients.Conclusions: In our setting, DKA is associated with markedly elevated HbA1c levels in known type 1, known type 2 and new onset diabetes.Key words: Glycosylated haemoglobin, ketoacidosis, Known and newly diagnosed diabete

Impacts of supplemental irrigation as a climate change adaptation strategy for maize production: a case of the Eastern Cape Province of South Africa S Ndhleve1*, MDV Nakin1 and B Longo-Mbenza1

Dry spells and climatic hazards are responsible for maize output decline, sometimes to levels below potential yield levels. There is a pressing need to reduce the gap between actual and potential maize yield/ha, especially among farmers in semi-arid regions. This present study examines the potential role of supplemental irrigation and its differential impact on maize yield in the Eastern Cape Province of South Africa. In this study, maize yield data were generated from information recorded over a period of 20 years by farmers in Ntabankulu through cross-sectional interviews with 124 randomly-selected farming households. Maize yields for interviewed farmers were analysed for each of the experienced climatic hazards, for yield decline per ha and preferable adaptation strategies. Maize yield analyses show a maximum ceiling/attainable yield of 0.234 t/ha and average farm yield of 0.146 t/ha. Floods or hailstorms cause 75% decline in maize yield/ha and there was no significant difference between farmers practising irrigation and those practising dryland farming (P > 0.05). Low/no rains throughout the season; delay or low onset of rainfall and a rain-break for a week or more in a season results in 75%; 54% and 50.5% decline in maize yield/ha, respectively. On a scale of 1 to 10, farmers highly rank practicing supplementary irrigation (8.4) and change of planting date (7.8) as important adaptation strategies. Rescheduling planting date from the traditional planting times to earlier or later planting dates, assisted by use of weather reports and forecasting, to some extent curbs the impact of delays or slow onset of rainfall on yield. Supplemental irrigation is instrumental in reducing the impact of mid-season drought (rains break for a week) and light rainfall throughout the season. Analyses of actual yields and yield decline against each of the experienced climatic hazards provided insight into management possibilities to stabilize maize output.Keywords: agronomic practices, climatic hazards, supplemental irrigation, semi-arid area

Hyperglycaemic crisis in the Eastern Cape province of South Africa: High mortality and association of hyperosmolar ketoacidosis with a new diagnosis of diabetes

Objectives. To describe the frequencies, presenting characteristics (demographic, clinical and biochemical) and outcomes (duration of admission and mortality rates) for various types of hyperglycaemic crisis. Methods. Retrospective review of medical records of patients with hyperglycaemic crisis admitted to Nelson Mandela Academic Hospital, Mthatha, E Cape, from 1 January 2008 to 31 December 2009. Outcome measures were duration of admission and mortality. Results. Data were available for 269 admissions (response rate 81.0%), 169 females and 100 males. Admissions for hyperglycaemia (HG, N=119), and non-hyperosmolar diabetic ketoacidosis (NHDKA, N=97) were more frequent than those for hyperosmolar hyperglycaemic state (HHS, N=29) and hyperosmolar diabetic ketoacidosis (HDKA, N=24). Duration of admission was similar in all groups. Mortality was high in all groups, but was higher in patients with HDKA (37.5%, risk ratio (RR) 3.88, 95% confidence interval (CI) 1.41 - 10.67, p=0.009), HHS (31.0%, RR 2.91, 95% CI 1.09 - 7.75, p=0.033) and HG (19.5%, RR 1.56, 95% CI 0.75 - 3.21, p=0.236) than in those with NHDKA (13.4%). HDKA (62.5%) was associated with new-onset diabetes more often than NHDKA (27.8%), HHS (44.8%) or HG (17.6%) (

Iodine deficiency in pregnancy along a concentration gradient is associated with increased severity of preeclampsia in rural Eastern Cape, South Africa

Background Preeclampsia is a leading cause of maternal mortality and morbidity in South Africa. Iodine deficiency in pregnancy, which is amenable to correction through iodine supplementation, has been reported to increase the risk of preeclampsia. However, the association of iodine nutrition status with preeclampsia in South Africa has not been studied. Methods We enrolled 51 randomly selected normotensive pregnant controls at term together with 51 consecutively selected cases of preeclampsia and 51 cases of severe preeclampsia/eclampsia, all in the third trimester, from Mthatha Regional and Nelson Mandela Academic Hospital in the Eastern Cape Province. Urinary iodine concentration (UIC), serum thyroid-stimulating hormone (TSH), triiodothyronine (FT3), thyroxine (FT4) and thyroglobulin (Tg) levels were compared between cases and controls. Results The respective chronological and gestational ages at enrolment for normotensive, preeclampsia and severe preeclampsia/eclampsia participants were: age 23, 24 and 19 years (p = 0.001), and gestational age 38, 34, and 35 weeks (p  0.05). The respective median values for normotensive, preeclampsia and severe preeclampsia/eclampsia participants were UIC 217.1, 127.7, and 98.8 μg/L; FT4 14.2, 13.7, and 12. pmol/L; FT3 4.8, 4.4, and 4.0 pmol//L; Tg 19.4, 21.4, and 32. Nine microgram per liter; TSH 2.3, 2.3, and 2.5 mIU/L. UIC  16 μg/L and FT4 < 11.3 pmol/L were independent predictors of preeclampsia/eclampsia syndrome. Conclusion Women with severe preeclampsia/eclampsia had significantly low UIC and high Tg, suggesting protracted inadequate iodine intake. Inadequate iodine intake during pregnancy severe enough to cause elevated Tg and FT4 deficiency was associated with an increased risk of severe preeclampsia/eclampsia

Nose and throat complications associated with passive smoking among Congolese school children

Objective: To assess associations between nose-throat (NT) diseases and passive smoking prevalence among school children.Methods: A cross-sectional survey was carried out on a randomized multistage sample of 381 school children (50.9% males, aged 9.8 &plusmn; 3.5 years) from Kinshasa town. Parents and children were asked to fill in a questionnaire detailing their smoking habits. The NT symptoms and diseases were assessed by the survey NT specialist.Results: The prevalence of passive smoking was 38.6% (n=147). Residence in peripheral areas, catholic school system, elementary level, exposure of family to passive smoking ,history of NT surgery, medicines and menthol inhaling, headache, nasal pain, dysphagia, odynophagia, dysosmia, dysphonia, pharyngeal irritation, dry throat, snooze, , and chronic pharyngitis were more reported by passive smokers. After adjusting for confounding factors, passive smoking (OR=16.7 95%CI 3.3-83.3), catholic system(OR=2 95%CI 1.2-3.2), and elementary degree(OR=1.4 95%, CI 1.1-2.1) were identified as independent determinants of chronic pharyngitis.Conclusion: Parents should not smoke in the same room used by their children.Keywords: Passive smoking, children, nose, throat, chronic pharyngitisAfrican Health Sciences 2011; 11(3): 315 - 32

Demographic profile and epidemiology of injury in Mthatha, South Africa

Objective: To determine the magnitude, socio-demographic and epidemiological characteristics of injury at a Provincial referral hospital.Methods: This review was conducted on all trauma patients admitted at the Mthatha Hospital Complex and Nelson Mandela Academic Hospital from the 1st January 1997 to the 31st December 2000.Results: The incident rate of injuries was 3.2% (n=2460/75,833 total admissions). Injured patients were mostly black (80%) and males (ratio: 5 men: 1 woman). Only 8.1% of injured patients were transported to hospital by ambulances. The leading causes of injuries were inter-personal violence accounting for 60% of cases, and motor vehicle accidents accounting for 19%; of them 38% were due to poor visibility, over speeding, and fatigue. The overall mortality was 33% (n=821) independently predicted by poverty (OR=8.2 95%CI 6-11.1; P40 years(OR=7.8 95%CI 7.7-12.1;P&lt;0.0001).Conclusion: The burden of injury is a mass issue that warrants regional attention with quality of care and training.Keywords: Injuries, violence, poverty, mortality, South AfricaAfrican Health Sciences 2013; 13(4): 1144 - 114