Methodological Challenges in Estimating Trends and Burden of Cardiovascular Disease in Sub-Saharan Africa

Background. Although 80% of the burden of cardiovascular disease (CVD) is in developing countries, the 2010 global burden of disease (GBD) estimates have been cited to support a premise that sub-Saharan Africa (SSA) is exempt from the CVD epidemic sweeping across developing countries. The widely publicized perspective influences research priorities and resource allocation at a time when secular trends indicate a rapid increase in prevalence of CVD in SSA by 2030. Purpose. To explore methodological challenges in estimating trends and burden of CVD in SSA via appraisal of the current CVD statistics and literature. Methods. This review was guided by the Critical review methodology described by Grant and Booth. The review traces the origins and evolution of GBD metrics and then explores the methodological limitations inherent in the current GBD statistics. Articles were included based on their conceptual contribution to the existing body of knowledge on the burden of CVD in SSA. Results/Conclusion. Cognizant of the methodological challenges discussed, we caution against extrapolation of the global burden of CVD statistics in a way that underrates the actual but uncertain impact of CVD in SSA. We conclude by making a case for optimal but cost-effective surveillance and prevention of CVD in SSA

Awareness, Treatment and Control of Hypertension in Kenya

The emerging epidemic of hypertension (HTN) in sub-Saharan Africa is predicted to worsen. Uncontrolled HTN is associated with CVD, high morbidity and premature mortality; hence early detection, treatment and control of HTN is critical to reduction of the associated sequelae. The study was guided by the Social Ecological Model and principles of Community Based Participatory Research

Global risk assessment of cardiovascular disease in resource constrained settings

Cardiovascular disease (CVD) is an emerging problem in Sub-Saharan Africa. Many current guidelines recommend using global risk assessment (GRA) to quantify the risk for developing CVD and to guide treatment and policy. Most GRA tools require lipid measures which are not readily available in resource-constrained settings. Of the 3 most published non-laboratory based tools: Gaziano and Framingham substitute BMI for cholesterol; WHO does not include BMI or cholesterol

The Global Health Service Partnership: An Academic–Clinical Partnership to Build Nursing and Medical Capacity in Africa

The World Health Organization estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses, and physicians) by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic health care, to respond to emerging and more complex needs, and to teach, graduate, and retain their future health professionals—a vicious cycle that is perpetuated and has profound implications for health security. The Global Health Service Partnership (GHSP) is a unique collaboration between the Peace Corps, President’s Emergency Plan for AIDS Relief, Seed and host-country institutions, which aims to strengthen the breadth and quality of medical and nursing education and care delivery in places with dire shortages of health professionals. Nurse and physician educators are seconded to host institutions to serve as visiting faculty alongside their local colleagues. They serve for 1 year with many staying longer. Educational and clinical best practices are shared, emphasis is placed on integration of theory and practice across the academic–clinical domains and the teaching and learning environment is expanded to include implementation science and dissemination of locally tailored and sustainable practice innovations. In the first 3 years (2013–2016) GHSP placed 97 nurse and physician educators in three countries (Malawi, Tanzania, and Uganda). These educators have taught 454 courses and workshops to 8,321 trainees, faculty members, and practicing health professionals across the curriculum and in myriad specialties. Mixed-methods evaluation included key stakeholder interviews with host institution faculty and students who indicate that the addition of GHSP enhanced clinical teaching (quality and breadth) resulting in improved clinical skills, confidence, and ability to connect theory to practice and critical thinking. The outputs and outcomes from four exemplars which focus on the translation of evidence to practice through implementation science are included. Findings from the first 3 years of GHSP suggest that an innovative, locally tailored and culturally appropriate multi-country academic–clinical partnership program that addresses national health priorities is feasible and generated new knowledge and best practices relevant to capacity building for nursing and medical education. This in turn has implications for improving the health of populations who suffer a disproportionate burden of global disease

THE PREVALENCE OF BLOOD PRESSURE AND CHOLESTEROL MONITORING IN BOSTON AMONG NON-HISPANIC BLACKS, HISPANICS, AND NON-HISPANIC WHITES

Objectives: Racial and ethnic minorities are at increased risk for hypertension and hypercholesterolemia. Appropriate blood pressure and cholesterol monitoring is a critical first step in identification, treatment, and control of these conditions and the prevention of coronary artery disease. This study examines blood pressure and cholesterol monitoring among non-Hispanic Black, Hispanic, and non-Hispanic White subjects. Design: Data were drawn from the 1999 Massachusetts Behavioral Risk Factor Surveillance Survey (BRFSS) Boston oversample. Monitoring for hypertension and hypercholesterolemia were compared across 2515 respondents to the 1999 Boston BRFSS oversample, including (67.6% White non-Hispanic, 18% Black non-Hispanic, and 14.4% Hispanic, any race). Chi square analyses were used to test unadjusted race- and ethnicity-specific differences, and logistic regression was used to estimate the odds of inadequate blood pressure and cholesterol monitoring by race/ ethnicity, adjusting for demographic characteristics, insurance, source of care, psychosocial factors, and neighborhood characteristics. Results: No significant differences were seen in the adequacy of blood pressure and cholesterol monitoring among the racial/ethnic groups of interest, despite significant differences in sociodemographic characteristics and morbidity. Conclusions: In this local dataset, non-Hispanic Blacks and Hispanics, as compared to non-Hispanic Whites, were not more likely to report inadequate blood pressure or cholesterol monitoring. The data suggest that safety net factors in place in Boston may have contributed to the observed parity in access to preventive care among the racial/ethnic groups of interest. The data also suggest that factors antecedent/subsequent to blood pressure and cholesterol monitoring may explain the observed disparities in blood pressure and cholesterol morbidity and control reported for racial/ethnic minorities

The Global Health Service Partnership: An Academic–Clinical Partnership to Build Nursing and Medical Capacity in Africa

The World Health Organization estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses, and physicians) by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic health care, to respond to emerging and more complex needs, and to teach, graduate, and retain their future health professionals—a vicious cycle that is perpetuated and has profound implications for health security. The Global Health Service Partnership (GHSP) is a unique collaboration between the Peace Corps, President’s Emergency Plan for AIDS Relief, Seed and host-country institutions, which aims to strengthen the breadth and quality of medical and nursing education and care delivery in places with dire shortages of health professionals. Nurse and physician educators are seconded to host institutions to serve as visiting faculty alongside their local colleagues. They serve for 1 year with many staying longer. Educational and clinical best practices are shared, emphasis is placed on integration of theory and practice across the academic–clinical domains and the teaching and learning environment is expanded to include implementation science and dissemination of locally tailored and sustainable practice innovations. In the first 3 years (2013–2016) GHSP placed 97 nurse and physician educators in three countries (Malawi, Tanzania, and Uganda). These educators have taught 454 courses and workshops to 8,321 trainees, faculty members, and practicing health professionals across the curriculum and in myriad specialties. Mixed-methods evaluation included key stakeholder interviews with host institution faculty and students who indicate that the addition of GHSP enhanced clinical teaching (quality and breadth) resulting in improved clinical skills, confidence, and ability to connect theory to practice and critical thinking. The outputs and outcomes from four exemplars which focus on the translation of evidence to practice through implementation science are included. Findings from the first 3 years of GHSP suggest that an innovative, locally tailored and culturally appropriate multi-country academic–clinical partnership program that addresses national health priorities is feasible and generated new knowledge and best practices relevant to capacity building for nursing and medical education. This in turn has implications for improving the health of populations who suffer a disproportionate burden of global disease

Interventions to Promote Physical Activity and Dietary Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults: A Scientific Statement from the American Heart Association

Even modest sustained lifestyle changes can substantially reduce cardiovascular disease (CVD) morbidity and mortality. Because many of the beneficial effects of lifestyle changes accrue over time, long-term adherence maximizes individual and population benefits. Interventions targeting dietary patterns, weight reduction, and new PA habits often result in impressive rates of initial behavior changes, but frequently are not translated into long-term behavioral maintenance. Both adoption and maintenance of new cardiovascular risk-reducing behaviors pose challenges for many individuals. According to the National Center for Health Statistics, life expectancy could increase by almost 7 years if all forms of major CVD were eliminated.5 Improvements in morbidity and quality of life would also be substantial. In order to achieve these goals, healthcare providers must focus on reducing CVD risk factors such as overweight and obesity, poor dietary habits, and physical inactivity by helping individuals begin and maintain dietary and PA changes. The purpose of this scientific statement is to provide evidence-based recommendations on implementing PA and dietary interventions among adult individuals, including adults of racial/ethnic minority and/or socioeconomically disadvantaged populations. The most efficacious and effective strategies are summarized, and guidelines are provided to translate these strategies into practice. Individual, provider, and environmental factors that may influence the design of the interventions, as well as implications for policy and for future research, also are briefly addressed

Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: A scientific statement from the american heart association

Even modest sustained lifestyle changes can substantially reduce cardiovascular disease (CVD) morbidity and mortality. Because many of the beneficial effects of lifestyle changes accrue over time, long-term adherence maximizes individual and population benefits. Interventions targeting dietary patterns, weight reduction, and new PA habits often result in impressive rates of initial behavior changes, but frequently are not translated into long-term behavioral maintenance. Both adoption and maintenance of new cardiovascular risk-reducing behaviors pose challenges for many individuals. According to the National Center for Health Statistics, life expectancy could increase by almost 7 years if all forms of major CVD were eliminated.5 Improvements in morbidity and quality of life would also be substantial. In order to achieve these goals, healthcare providers must focus on reducing CVD risk factors such as overweight and obesity, poor dietary habits, and physical inactivity by helping individuals begin and maintain dietary and PA changes. The purpose of this scientific statement is to provide evidence-based recommendations on implementing PA and dietary interventions among adult individuals, including adults of racial/ethnic minority and/or socioeconomically disadvantaged populations. The most efficacious and effective strategies are summarized, and guidelines are provided to translate these strategies into practice. Individual, provider, and environmental factors that may influence the design of the interventions, as well as implications for policy and for future research, also are briefly addressed