Right ventricular systolic function in Nigerians with heart failure secondary to hypertensive heart disease

Background: Right ventricular (RV) dysfunction has been shown to be a major contributor to the adverse outcomes in subjects with heart failure. Few studies evaluating the right ventricle in heart failure subjectshave been carried out in Sub-Saharan Africa. This study was therefore designed to evaluate the right ventricular systolic function in subjects with heart failure secondary to hypertensive heart disease presenting to the University College Hospital, Ibadan Nigeria.Methodology: Seventy-six subjects with heart failure secondary to hypertension and 92 normal controls underwent clinical, electrocardiographic and echocardiographic evaluation. Indices of right ventricular systolic function that were measured include tricuspid annular plane systolic excursion (TAPSE), tissue Doppler derived tricuspid peak systolic lateral annulus velocity(S') and right ventricular fractional areachange(RVFAC).Results: Sixty-two (81.6%) heart failure subjects had right ventricular systolic dysfunction, 31(40.8%) had abnormal TAPSE, 42(55.5%) had abnormal S' while 49(64.5%) had abnormal RVFAC. Elevated pulmonary artery systolic pressure was found in 25(32.9%) of the subjects. There was no relationship between the indices of right ventricular systolic function and the estimated systolic pulmonary artery pressures. The independent predictor of right ventricular systolic dysfunction was the right atrial size.Conclusion: Right ventricular systolic function is impaired in patients with heart failure secondary to hypertensive heart disease. There is no relationship between the indices of right ventricular systolic function and systolic pulmonary artery pressure. Furtherstudies are needed to assess right ventricular systolic function in Nigerians.Keywords: Hypertension, Heart Failure, Right ventricular dysfunction, Nigeria, Sub- Saharan Africa

Preliminary study of perceived cardiovascular disease risk and risk status of adults in small rural and urban locations in Ibadan, Nigeria

The burden of cardiovascular disease (CVD) has been on the rise in developing countries like Nigeria recently. Studies on perceived CVD risk and the risk status of adults in Ibadan are not readily available, hence this study. A mixed-method design involving a cross-sectional survey and an exploratory qualitative study was utilized. Convenience sampling was used to recruit 418 participants (209 from rural and 209 from urban) for the cross-sectional survey, while purposive sampling was used to recruit 14 participants for the qualitative aspect. The INTERHEART risk score and the Perception of Risk of Heart Disease Scale were used to investigate participants' CVD risk status and perceived risk, respectively. The data from the cross-sectional survey were summarized by using descriptive statistics, and the data were then analyzed by using the chi-square test of association and a multiple logistic regression model, while content thematic analysis was used to analyze the qualitative data. In the rural and urban areas, respectively, 39.7% and 52.2% had a positive perception of CVD risk. In the rural and urban areas, 44% and 41.6% of individuals respectively had moderate-to-high risk of CVD. Participants with at least secondary school education [2.66 (0.61–11.53)] and participants in the urban area [2.62 (0.78–7.08)] had twice higher odds of positive CVD risk perception. Males [3.91 (1.58–9.68)], adults aged 40 and above [1.59 (0.63–4.00)] and urban dwellers [1.21 (0.33–4.39)] had higher odds of a high CVD risk status. The qualitative aspect of the study corroborated the findings from the survey, as many participants did not perceive themselves as being at risk of CVD. The majority of the participants in this study were found to have a moderate-to-high risk of CVD, and many had a negative perception of their risk. Health education and CVD prevention programs are required to curb the burden of CVD

Right ventricular systolic function in Nigerians with heart failure secondary to hypertensive heart disease

Background: Right ventricular (RV) dysfunction has been shown to be a major contributor to the adverse outcomes in subjects with heart failure. Few studies evaluating the right ventricle in heart failure subjects have been carried out in Sub-Saharan Africa. This study was therefore designed to evaluate the right ventricular systolic function in subjects with heart failure secondary to hypertensive heart disease presenting to the University College Hospital, Ibadan Nigeria. Methodology: Seventy-six subjects with heart failure secondary to hypertension and 92 normal controls underwent clinical, electrocardiographic and echocardiographic evaluation. Indices of right ventricular systolic function that were measured include tricuspid annular plane systolic excursion (TAPSE), tissue Doppler derived tricuspid peak systolic lateral annulus velocity(S') and right ventricular fractional areachange(RVFAC). Results: Sixty-two (81.6%) heart failure subjects had right ventricular systolic dysfunction, 31(40.8%) had abnormal TAPSE, 42(55.5%) had abnormal S' while 49(64.5%) had abnormal RVFAC. Elevated pulmonary artery systolic pressure was found in 25(32.9%) of the subjects. There was no relationship between the indices of right ventricular systolic function and the estimated systolic pulmonary artery pressures. The independent predictor of right ventricular systolic dysfunction was the right atrial size. Conclusion: Right ventricular systolic function is impaired in patients with heart failure secondary to hypertensive heart disease.There is no relationship between the indices of right ventricular systolic function and systolic pulmonary artery pressure. Further studies are needed to assess right ventricular systolic function in Nigerians. DOI: https://dx.doi.org/10.4314/ahs.v19i2.37 Cite as: Ifeoluwa AA, Adebiyi AA, Adeoye AM, Akinyemi A. Right ventricular systolic function in subjects with heart failure secondary to hypertensive heart disease. Afri Health Sci.2019;19(2): 2130-2139. https://dx.doi.org/10.4314/ahs.v19i2.3

Atrial Fibrillation in Africa-An Underreported and Unrecognized Risk Factor for Stroke:A Systematic Review

Over three-quarters of deaths from cardiovascular disease and diabetes occur in low- and middle-income countries, which include many African countries. Global studies showed that the prevalence of the cardiac arrhythmia atrial fibrillation (AF) appeared to be lower in Africa. A systematic search of PubMed and African Journals Online was conducted to determine the prevalence of AF and associated stroke risk factors in Africa and to quantify the need for screening. The publications search yielded a total of 840 articles of which 41 were included. AF was often not identified as the disease of primary interest with its own risks. Data on prevalence in the general population was scarce. The prevalence of stroke risk factors showed a large variation between studies, as well as within clustered subpopulations. AF in Africa is under-reported in published reports. The study types and populations are highly heterogeneous, making it difficult to draw a definitive conclusion on AF prevalence

Factors Associated with Treatment Success among Pulmonary Tuberculosis and HIV Co-infected Patients in Oyo State, South West-Nigeria

Background The co-existence of Tuberculosis (TB) and Human immunodeficiency Virus (HIV) is  known to increase morbidity and mortality in patients. The determinants of treatment success in TBHIV co-infection are not yet well studied. Such information can help optimise treatment and reduce morbidity and mortality.Objective To determine factors associated with antitubercular treatment success among TB I HIV coinfected patients.Methods A cross sectional study was carried out in fifty  three DOT clinics and treatment centres  using tuberculosis patient's records from January 2009 to December 2010 in Oyo state, Nigeria. The study population consisted of 7905 tuberculosis patients. Information on variables of interest were obtained with the use of data extraction forms. Chi-square and logistic regression were used to test the relationship between TB I HIV coinfection and socio-demographic variables, clinical characteristics and treatment success.Results Prevalence ofTB I HIV co-infection was found to be 14.2%. Patients with TB-HIV co-infection  were younger and more likely to be females. There were statistically significant association between treatment success and gender, marital status and patient point of care. After adjusting for other variables, it was found that patients receiving treatment in private facilities were independently less likely to be successfully treated compared with those receiving care in Public facilities. Female patients were also independently more likely to have better treatment outcome than male.Conclusion In addition to patients' point of care, gender of the patients can adversely impact on their treatment success. Efforts from the government to strengthening the private public mix, health education and media awareness on adherence to treatment to improve treatment success should be intensified in the country.Keywords: Tube rc ulosis; Human immunodeficiency virus, Directly observe therapy short-course;  Treatment success, Coinfection

Exploring Overlaps Between the Genomic and Environmental Determinants of LVH and Stroke: A Multicenter Study in West Africa

Background Whether left ventricular hypertrophy (LVH) is determined by similar genomic and environmental risk factors with stroke, or is simply an intermediate stroke marker, is unknown. Objectives We present a research plan and preliminary findings to explore the overlap in the genomic and environmental determinants of LVH and stroke among Africans participating in the SIREN (Stroke Investigative Research and Education Network) study. Methods SIREN is a transnational, multicenter study involving acute stroke patients and age-, ethnicity-, and sex-matched control subjects recruited from 9 sites in Ghana and Nigeria. Genomic and environmental risk factors and other relevant phenotypes for stroke and LVH are being collected and compared using standard techniques. Results This preliminary analysis included only 725 stroke patients (mean age 59.1 ± 13.2 years; 54.3% male). Fifty-five percent of the stroke subjects had LVH with greater proportion among women (51.6% vs. 48.4%; p \u3c 0.001). Those with LVH were younger (57.9 ± 12.8 vs. 60.6 ± 13.4; p = 0.006) and had higher mean systolic and diastolic blood pressure (167.1/99.5 mm Hg vs 151.7/90.6 mm Hg; p \u3c 0.001). Uncontrolled blood pressure at presentation was prevalent in subjects with LVH (76.2% vs. 57.7%; p \u3c 0.001). Significant independent predictors of LVH were age \u3c45 years (adjusted odds ratio [AOR]: 1.91; 95% confidence interval [CI]: 1.14 to 3.19), female sex (AOR: 2.01; 95% CI: 1.44 to 2.81), and diastolic blood pressure \u3e 90 mm Hg (AOR: 2.10; 95% CI: 1.39 to 3.19; p \u3c 0.001). Conclusions The prevalence of LVH was high among stroke patients especially the younger ones, suggesting a genetic component to LVH. Hypertension was a major modifiable risk factor for stroke as well as LVH. It is envisaged that the SIREN project will elucidate polygenic overlap (if present) between LVH and stroke among Africans, thereby defining the role of LVH as a putative intermediate cardiovascular phenotype and therapeutic target to inform interventions to reduce stroke risk in populations of African ancestry

Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans

Background Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans. Objectives The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study. Methods We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS). Results Patients\u27 mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p = 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02). Conclusions About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability

Evaluating the effectiveness of African School of Hypertension for non-physician health workers, a qualitative study : QuASH hypertension study

DATA ACCESSIBILITY STATEMENT : The data that supports the findings of this study are available from the corresponding author upon reasonable request.BACKGROUND : The implementation of task sharing and shifting (TSTS) policy as a way of addressing the shortage of physicians and reducing the burden of hypertension in Africa birthed the idea of the African School of Hypertension (ASH). The ASH is saddled with the responsibility of training non-physician health workers across Africa continent in the management of uncomplicated hypertension. AIM : To get feedback from some faculty members and students who participated in the first ASH programme. METHODS : This was a cross-sectional exploratory qualitative study conducted among eight students and eight faculty members. Feedback from the program was obtained by conducting in-depth interviews centred on description of course content; expectations and knowledge acquired from ASH; level of interaction between students and faculty members; challenges faced during the ASH; level of implementation of acquired training; and suggestions to improve subsequent ASH programs. RESULTS : The course content of the ASH was described as simple, appropriate and adequate while interaction between students and faculty members were highly cordial and engaging. New knowledge about hypertension management was acquired by the students with different levels of implementation post-graduation. Some identified challenges with the ASH program were poor internet connectivity during lectures, non-uniformity of TSTS policies and hypertension management guidelines across Africa, technical problems with hypertension management app and low participation from other African countries apart from Nigeria. Some recommendations to improve ASH program were development of a uniform hypertension management guideline for Africans, wider publicity of the ASH, interpretation of lectures into French and Portuguese languages and improvement of internet connectivity. CONCLUSION : The ASH programme has largely achieved its objectives with the very encouraging feedback received from both faculty members and the students. Steps should be taken to address the identified challenges and implement the suggested recommendations in subsequent ASH program to sustain this success.https://globalheartjournal.com/hj2024Early Childhood EducationSDG-04:Quality Educatio

Clinical Outcomes in 3343 Children and Adults with Rheumatic Heart Disease from 14 Low and Middle Income Countries: 2-Year Follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY study)

Background: There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia. Methods: Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis. Results: Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18–40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80–3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70–2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32–2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10–1.78), and older age (HR, 1.02; 95% CI, 1.01–1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54–0.85) and female sex (HR, 0.65; 95% CI, 0.52–0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle–income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle–income countries. Valve surgery was significantly more common in upper-middle–income than in lower-middle– or low-income countries. Conclusions: Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle–income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes. </jats:sec

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic