Aging, female sex, migration, elevated HDL-C, and inflammation are associated with prevalence of metabolic syndrome among African bank employees

Thierry Gombet,1 Benjamin Longo-Mbenza,2 Bertrand Ellenga-Mbolla,1 Meo Stephane Ikama,3 Etienne Mokondjimobe,4 Gisele Kimbally-Kaky,3 Jean-Louis Nkoua,31Emergency Department, University Hospital Center of Brazzaville, Brazzaville, Congo; 2Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa; 3Department of Cardiology and Internal Medicine, University Hospital Center of Brazzaville, Brazzaville, Congo; 4Laboratory of Biochemistry and Pharmacology, Faculty of Health Sciences, Brazzaville, CongoBackground: The objective of this study was to compare four different criteria for diagnosing metabolic syndrome (MS) and to correlate sociodemographic data, liver enzymes, lipids, inflammation, and insulin resistance with MS definitions.Methods: This cross-sectional study included a random number of 126 African bank employees from Brazzaville, Congo.Results: The prevalence of MS varied according to the different definitions used: 4.8% under World Health Organization (WHO) criteria, 8.7% under the National Cholesterol Education Program Adult Treatment Panel III (NECP-ATPIII) criteria, 14.3% under the International Diabetes Federation (IDF) for Europe, and 15.9% by the IDF for Central Africa. According to the IDF, specific cutoff points for the erythrocyte sedimentation rate, ≥13 mm at first hour and ≥30 mm at second hour, defined MS for Central Africa. The best agreement was observed between the IDF for Europe and the IDF for Central Africa (Kappa = 0.938; P < 0.0001) criteria. The worst agreements were between the WHO and IDF for Central Africa (Kappa = 0.419; P < 0.0001) criteria and between the WHO and IDF for Europe (Kappa = 0.462; P < 0.0001) criteria. The NECP-ATPIII criteria did not agree with either the IDF for Europe or the IDF for Central Africa criteria. There was a significant relationship between female sex, aging, elevated liver enzymes, elevated phospholipids, high homeostasis model assessment of insulin resistance, and MS defined by the IDF for Central Africa.Conclusion: The IDF definition of the MS modified for Central Africa provides higher prevalence estimates of MS than the estimates based on the NECP-ATPIII and IDF for Europe criteria. Liver enzymes, phospholipids, and homeostasis model assessment of insulin resistance should be included in clinical practice to stratify cardiovascular disease risk among Africans.Keywords: metabolic syndrome, insulin resistance, inflammation, liver enzymes, atherosclerosis, sub-Saharan Africa&nbsp

Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans

Benjamin Longo-Mbenza,1 Jacqueline Nkondi Nsenga,2 Etienne Mokondjimobe,3 Thierry Gombet,3 Itoua Ngaporo Assori,3 Jean Rosaire Ibara,3 Bertrand Ellenga-Mbolla,3 Dieudonné Ngoma Vangu,4 Simon Mbungu Fuele41Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; 2Division of Gastroenterology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; 3Faculty of Health Sciences, University of Marien Ngouabi, Brazzaville, Democratic Republic of the Congo; 4Biostatistics Unit, Lomo Medical Center, Limete, Kinshasa, Democratic Republic of the CongoBackground: Helicobacter pylori is now incriminated in the pathogenesis of atherosclerosis.Objective: To examine the importance of H. pylori infection as a cardiovascular disease (CVD) risk factor.Methods: Two hundred five patients (128 with H. pylori infection [HP-seropositive] and 77 without) had a baseline assessment for other potential CVD risk factors and were followed prospectively for 10 years (1999–2008). They were assessed on a monthly basis for the outcomes of carotid plaque, angina pectoris, myocardial infarction, and stroke. In the HP-seropositive group, male sex and quartile 4 for IgG anti-H. pylori antibodies (anti-HP Ab) were correlated with traditional CVD risk factors, stroke, myocardial infarction, and angina pectoris.Results: At the baseline assessment, the levels of carotid intima-media thickness, blood fibrinogen, total cholesterol, fasting plasma glucose, and uric acid were higher in H. pylori-infected patients than in the uninfected group. Serum HDL-cholesterol was significantly lower in the HP-seropositive group. Men had higher levels of IgG anti-HP Ab, waist circumference, blood pressure, uric acid, and total cholesterol than women. Within the HP-seropositive group, individuals in quartile 4 for IgG anti-HP Ab had higher rates of elevated fibrinogen, diabetes mellitus, low high-density lipoprotein cholesterol, arterial hypertension, and high total cholesterol than those in quartile 1. After adjusting for traditional CVD risk factors, H. pylori infection was the only independent predictor of incident carotid plaque (multivariate odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.2–7.2; P < 0.0001) and incident acute stroke (multivariate OR = 3.6, 95% CI: 1.4–8.2; P < 0.0001). Within the HP-seropositive group and after adjusting for traditional CVD risk factors, male sex was the only independent predictor of incident angina pectoris (multivariate OR = 3.5, 95% CI: 1.6–16; P < 0.0001), incident acute stroke (multivariate OR = 3.2, 95% CI: 1.4–28; P < 0.0001), and acute myocardial infarction (multivariate OR = 7.2, 95% CI: 3.1–18; P < 0.0001).Conclusion: Our study provides evidence for an association among known CVD risk factors, carotid plaque, stroke, and H. pylori infection. Among infected individuals, there is a significant association among severity of HP-seropositivity, male sex, and CVD. The eradication of H. pylori infection may therefore reduce the emerging burden of CVD in Africa.Keywords: Helicobacter pylori, stroke, myocardial infarction, cardiovascular disease, carotid plaque, African

Dog rabies control in West and Central Africa: a review

Rabies is a neglected but preventable zoonotic disease that predominantly affects the most vulnerable populations living in remote rural areas of resource-limited countries. To date, every country on the African mainland is considered endemic for dog-mediated rabies with an estimated 21'500 human rabies deaths occurring each year. In 2018, the United Against Rabies collaboration launched the Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. The epidemiology of rabies from most Western and Central African countries remains poorly defined, making it difficult to assess the overall rabies situation and progress towards the 2030 goal. In this review, we attempt to provide an overview of the current rabies situation in 22 West and Central African countries based on published scientific literature and information obtained from rabies focal points. To this end, information was collected on i) established surveillance, ii) diagnostic capacity, iii) post-exposure prophylaxis (PEP) availability and coverage, iv) dog population estimates, v) dog vaccination campaigns, vi) animal and human health communication (One Health), vii) molecular studies, viii) Knowledge, Attitude and Practices (KAP), ix) cost estimates and x) national control strategies. Although rabies is a notifiable disease in the majority of the studied countries, national surveillance systems do not adequately capture the disease. A general lack of rabies diagnostic capacity has an additional negative impact on rabies surveillance and attempts to estimate rabies burden. Recurrent shortages of human rabies vaccine are reported by all of the countries, with vaccine availability usually limited to major urban centers but no country has yet adopted the new WHO-recommended 1-week intradermal vaccination regimen. Most countries carry out subsidized mass dog vaccination campaigns on World Rabies Day. Such activities are indispensable to keep rabies in the public consciousness but are not of the scale and intensity that is required to eliminate rabies from the dog population. Countries will need to scale up the intensity of their campaigns, if they are to progress towards the 2030 goal. But more than half of the countries do not yet have reliable figures on their dog populations. Only two countries reached stage 2 on the Stepwise Approach towards Rabies Elimination ladder - indicating that their national governments have truly prioritized rabies elimination and are thus providing the necessary support and political buy-in required to achieve success. In summary, the sub-region of West and Central Africa seems to be divided into countries which have accepted the challenge to eliminate rabies with governments committed to pushing forward rabies elimination, while other countries have achieved some progress, but elimination efforts remain stuck due to lacking government commitment and financial constraints. The possibility to meet the 2030 goal without international solidarity is low, because more than two-thirds of the countries rank in the low human development group (HDI </= 152). Leading countries should act as role models, sharing their experiences and capacities so that no country is left behind. Unified and with international support it is possible to reach the common goal of zero human rabies deaths by 2030