14 research outputs found
Estimating the burden of selected non-communicable diseases in Africa: a systematic review of the evidence
Background
The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and
particularly in Africa, where the health focus, until recently, has been on infectious diseases. The
response to this growing burden of NCDs in Africa has been affected owing to a poor
understanding of the burden of NCDs, and the relative lack of data and low level of research on
NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly
derived from modelling based on data from other countries imputed into African countries, and
not usually based on data originating from Africa itself. In instances where few data were
available, estimates have been characterized by extrapolation and over-modelling of the scarce
data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot
be unexpected. With a gradual increase in average life expectancy across Africa, the region now
experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy
lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on
understanding the prevalence, and/or where there are available data, the incidence, of four major
NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but
also globally.
Methods
I conducted a systematic search of the literature on three main databases (Medline, EMBASE and
Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and
extracted data from original population-based (cohort or cross sectional), and/or health service
records (hospital or registry-based studies) on prevalence and/or incidence rates of four major
NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes,
major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach,
colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic
obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and
incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An
epidemiological model was applied on all extracted data points. The fitted curve explaining the
largest proportion of variance (best fit) from the model was further applied. The equation
generated from the fitted curve was used to determine the prevalence and cases of the specific
NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population
estimates for Africa.
Results
From the literature search, studies on hypertension had the highest publication output at 7680, 92
of which were selected, spreading across 31 African countries. Cancer had 9762 publications and
39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across
28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had
790 publications and 45 were selected across 24 countries; and COPD had the lowest output with
243 publications and 13 were selected across 8 countries. From studies reporting prevalence
rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a
prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample
size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD,
with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4,
22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence
of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94
million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies
reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a
prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total
of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a
total population of about 33 million. Among women, cervical cancer and breast cancer had 129
thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0,
22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma
closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9,
18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively.
Conclusion
This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular
diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases
(COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on
many NCDs across the continent, there are still doubts on the true prevalence of these diseases
relative to the current African population. There is need for improvement in health information
system and overall data management, especially at country level in Africa. Governments of
African nations, international organizations, experts and other stakeholders need to invest more
on NCDs research, particularly mortality, risk factors, and health determinants to have
evidenced-based facts on the drivers of this epidemic in the continent, and prompt better,
effective and overall public health response to NCDs in Africa
May measurement month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension (vol 40, pg 2006, 2019)
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 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 https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight 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 obesity
In-hospital mortality among Black patients admitted for hypertension-related disorders in Mbuji Mayi, Congo
BACKGROUND: As a consequence of hypertension, sub-Saharan Africa faces an epidemic of cardiovascular disease. METHODS: We assessed in-hospital mortality among patients admitted for hypertension-related diseases to two city hospitals in Mbuji Mayi, Congo. On admission, we obtained anthropometric measurements, blood pressure, information on cardiovascular risk factors, and on the awareness and treatment of hypertension. We modeled the probability of death, using stepwise logistic regression. RESULTS: Of 401 consecutive patients (mean age, 54.3 years; 129 women), 118 (29.4 %) were unaware of their hypertension. Among 283 aware patients (70.6%), 126 (44.5%) were untreated. Systolic/diastolic blood pressure on admission averaged 178/106 mm Hg. In addition to hypertension, 390 patients (97.3%) had other cardiovascular risk factors, including a creatinine clearance below 60 ml/min/1.73 m(2) in 47 subjects (11.7%). Over 15 days (median) of hospitalization, 89 deaths (22.2%) occurred. The multivariable-adjusted probability of death increased with systolic blood pressure (odds ratio (95% confidence interval) for +10 mm Hg, 1.43 (1.15-1.77); P < 0.01), body mass index (+5 kg/m(2), 2.40 (1.39-4.17); P < 0.01), being aware vs. unaware of hypertension (3.17 (1.52-6.61); P < 0.01), and being untreated (2.33 (1.12-4.76); P < 0.05), but it decreased with age (+10 years, 0.65 (0.46-0.92); P < 0.05) and higher creatinine clearance (+10 ml/min/1.73 m(2), 0.71 (0.61-0.82); P < 0.001). CONCLUSIONS: The in-hospital mortality among African patients hospitalized for hypertension-related disorders in a Congolese provincial capital city is over 20%. These findings underscore that screening and treatment for hypertension and the prevention of cardiovascular disease should be placed much higher on the political agenda in sub-Saharan Africa.status: publishe
Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa
To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After 4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.Journal of Human Hypertension advance online publication, 27 June 2013; doi:10.1038/jhh.2013.56.status: publishe
Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa
To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30–69 years) with uncomplicated hypertension (140–179/90–109 mm Hg). After ⩾4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5–2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (–0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients