Atrial fibrillation in sub-saharan Africa: epidemiology, unmet needs, and treatment options

Health care in Sub-Saharan Africa is being challenged by a double burden of disease as lifestyle diseases common in the developed world, such as stroke and atrial fibrillation (AF), increase, while, simultaneously, health issues of the developing world in terms of communicable disease persist. The prevalence of AF is lower in Africa than in the developed world but is expected to increase significantly over the next few decades. Patients with AF in Africa tend to be younger and have a higher prevalence of rheumatic valvular heart disease than patients with AF in other regions. Permanent AF is the most prevalent type of AF in Africa, possibly due to the lower use of rhythm control strategies than in the developed world. Mortality rates of patients with AF in Africa are high, due largely to poor health care access and suboptimal therapy. The risk of stroke in AF, which is moderate to high in Africans as in the developed world, contributes to the high mortality rate. Patients with AF in Africa are often undertreated with antithrombotics, as cost and access to monitoring are major barriers. Vitamin K antagonists, including warfarin, are the most commonly available oral anticoagulants, but regular monitoring can be challenging, especially for patients in remote areas. Several non-vitamin K antagonist oral anticoagulants (NOACs) have been approved for use in countries across Sub-Saharan Africa and have the potential to reduce stroke burden. The higher cost of newer agents may be offset by the reduced need for regular monitoring, fixed dosing, and lower risk of intracranial bleeding; NOACs could provide a treatment option for patients in remote areas with limited access to regular monitoring. However, NOACs are not indicated in valvular AF. More work is needed to increase understanding of the epidemiology of AF and stroke, as well as to improve management strategies to reduce the burden of cardiovascular disease predicted for Africa

Irrigated Improved forages for smallholder dairy in Kilosa, Mvomero and Babati Districts, Tanzania

Irish Ai

Forage choppers and crop residue based rations for cattle

United States Agency for International Developmen

Acute Myeloid Leukemia: The Aga Khan Experience

AML is characterized by an increase in the number of myeloid cells in the marrow and an arrest in their maturation

Long-Term Outcomes and Factors Associated with Mortality in Patients with Moderate to Severe Pulmonary Hypertension in Kenya

Background: Pulmonary hypertension is poorly studied in Africa. The long-term survival rates and prognostic factors associated with mortality in patients with moderate to severe pulmonary hypertension (PH) in Africa are not well described. Objectives: To determine the causes of moderate to severe PH in patients seen in contemporary hospital settings, determine the patients’ one-year survival and the factors associated with mortality following standard care. Methods: A retrospective review of patients diagnosed with moderate to severe PH at Aga Khan University Hospital (AKUHN) from August 2014 to July 2017 was carried out. Clinical and outcome data were collected from medical records and the hospital mortality database. Telephone interviews were conducted for patients who died outside the hospital. Survival analysis was done using Kaplan-Meier, and log-rank tests were used to assess differences between subgroups. Cox regression modelling with multivariable adjustment was used to identify factors associated with all-cause mortality. Results: A total of 659 patients with moderate to severe PH were enrolled. Median follow-up time was 626 days. The survival rates of the patients at 1 and 2 years were 73.8% and 65.9%, respectively. The following variables were significantly associated with mortality: diabetes mellitus [adjusted HR 1.52, 95% CI (1.14–2.01)], WHO functional class III/IV [adjusted HR 3.49, 95% CI (2.46–4.95)], atrial fibrillation [adjusted HR 1.53, 95% CI (1.08–2.17)], severe PH [adjusted HR 1.72, 95% CI (1.30–2.27)], right ventricular dysfunction [adjusted HR 2.42, 95% CI (1.76–3.32)] and left ventricular dysfunction [adjusted HR 1.91, 95% CI (1.36–2.69)]. Obesity [adjusted HR 0.68, 95% CI (0.50–0.93)] was associated with improved survival. Conclusion: Pulmonary hypertension is associated with poor long-term outcomes in African patients. Identification of prognostic factors associated with high-risk patients will assist in patient management and potentially improved outcomes

Predictors of coronary artery disease in heart failure with reduced ejection fraction at the Aga Khan University Hospital in Nairobi

There appears to be an epidemiological transition in the etiology of heart failure in sub-Saharan Africa (SSA) in parallel with a steady increase in risk factors for coronary artery disease (CAD). SSA has limited access to heart failure and CAD diagnostics, limiting the number of patients who receive optimal care. Our objectives were to study the predictors of coronary artery disease among patients with heart failure with reduced ejection fraction (HFrEF) and develop a model to assist clinicians in determining the likelihood of CAD before cardiac catheterization. Methodology: This was a retrospective study at the Aga Khan University Hospital, Nairobi, which is equipped with diagnostic capabilities for heart failure and coronary artery assessment. We evaluated patients with HFrEF based on echocardiographic data over a 12-year period. Patients with coronary anatomical evaluation data were included. A multivariable model of CAD was generated using stepwise logistic regression. Results: Of the 1329 patients screened, 514 met the inclusion criteria. The mean age was 61.0 ± 12.8 years. There were 381 male cases (75.2%), and the predominant race was African, numbering 386 (75.2%). Most patients, 97%, were evaluated through conventional coronary angiography. Further, 310 (60.3%) cases had significant CAD. The prevalence of CAD in HFrEF was 52.3% in Africans, 85% in Asians, and 79% in Caucasians. In the multivariable logistic regression, the odds of having significant CAD was higher among participants with diabetes mellitus (aOR: 1.86; 95%CI: 1.15–3.03), Q waves (aOR: 2.12; 95%CI: 1.12–4.10), significant ST segment deviation (aOR: 4.14; 95%CI: 2.23–8.03), and regional wall motion abnormalities on echocardiogram (aOR: 6.53; 95%CI: 3.94–11.06). Conclusion: In this population, CAD was a major etiology in HFrEF among the African population. The most powerful predictors of CAD were type 2 diabetes, the presence of pathological Q waves, or ST segment shift on a 12-lead electrocardiogram, and regional wall motion abnormality on 2D echocardiogram

Safe Thrombolysis During Pregnancy for Recurrent Acute Ischaemic Stroke Due to Concomitant Isolated Left Ventricular Non-Compaction and Bilateral Foetal Posterior Communicating Arteries

Isolated left ventricular non-compaction (ILVNC) is a rare congenital cardiomyopathy and is associated with arrhythmias, heart failure and thromboembolism including ischaemic stroke. Pregnancy is a relative contraindication to thrombolysis for acute ischaemic stroke, although case reports suggest the treatment can be given in selected cases. We report a case of recurrent cryptogenic strokes in a 36-year-old female who was thrombolysed with good outcome at 37 weeks’ gestation and was eventually found to have ILVNC as the cause. She had a predilection to recurrent posterior circulatory strokes due to foetal posterior communicating arteries. To our knowledge this is the first case report of safe thrombolysis for acute ischaemic stroke in pregnancy caused by ILVN

Interferências de Línguas Moçambicanas em Português falado em Moçambique

Quando dois povos entram em contacto durante um período considerável, como é o caso dos portugueses e moçambicanos, entre os vários aspectos, as suas línguas acabam por se influenciar mutuamente (Sapir 1921) através de aparecimento de alguns traços de uma língua no discurso de falantes da outra língua. Em literatura linguística, se o traço linguístico de uma língua que aparece na outra for generalizado, este fenómeno, chama-se empréstimo, mas se for esporádico e (quase) individual, chama-se interferência (Ngunga 2009), pois o processo de aquisição de uma língua não materna implica utilização dos órgãos do aparelho fonador e de processos psicológicos formatados para uso na produção de sons e outras estruturas da língua materna. Este exercício pode resultar no que os professores de línguas chamam de “erros” resultantes de transferência de estruturas da língua materna para a língua alvo (Cardoso 2007). Baseado no método de observação que consistiu na escuta, recolha e sistematização de enunciados produzidos por moçambicanos ao longo de cerca de três décadas, este artigo visa estudar as interferências de línguas moçambicanas na língua portuguesa nas áreas fonética, fonológica, sintáctica e semântica. Os resultados desta investigação mostram que o surgimento inadvertido de traços das línguas moçambicanas no Português pode afectar o processo de comunicação nesta língua. Por isso, o texto sugere algumas estratégias para ajudar o professor a encontrar possíveis exercícios para minimizar as dificuldades de aprendizagem de Português como língua não materna por alunos moçambicanos.Palavras-chave: interferência, aquisição de língua, língua materna, língua não materna, língua bantu, língua portugues

Os desafios da investigação linguística em África: o caso de Moçambique

O estudo das línguas moçambicanas tem conhecido melhores tempos nas últimas décadas como resultado do que se pode chamar crescimento da consciência dos moçambicanos sobre a necessidade de construir uma nação forte, próspera e desenvolvida, o que só é possível numa sociedade democrática onde cada ator está consciente do seu papel no processo de desenvolvimento. A decisão sobre a introdução das línguas no ensino básico em Moçambique, através do modelo de ensino bilingue, fundamentada na necessidade de remoção de um dos mais importantes obstáculos do sucesso escolar, marcou um dos momentos mais importantes de rutura entre a visão nacionista (Fishman 1968) da política linguística moçambicana adotada nos primeiros tempos da independência e a visão nacionalista (Fishman op. cit.) e democrática onde a contribuição de cada moçambicano na construção de estado de direito é valorizada. Este triunfo de visão nacionalista sobre a visão nacionista coloca aos moçambicanos, sobretudo aos linguistas, para começar, grandes desafios. Com efeito, ao mesmo tempo que a referida decisão veio estimular a investigação tanto através de estudos visando analisar o impacto da decisão política de introdução das línguas no ensino (Moisés 2011, Ngunga et al. 2010) na educação em geral como da descrição da gramática das línguas visando municiar os professores, alunos e técnicos de educação de conhecimentos sobre a estrutura e o funcionamento destas línguas (NGUNGA 2002, NGUNGA e SIMBINE 2012, LANGA 2012, MACALANE 2012). A presente comunicação apresenta o estado atual da investigação das línguas africanas em Moçambique à luz dos desenvolvimentos mais recentes da situação sociopolítica do país