Medication Adherence Interventions for Cardiovascular Disease in Low- and Middle-Income Countries: A Systematic Review.

Purpose: The burden of cardiovascular diseases (CVD) is high in low- and middle-income countries (LMICs). Medications are integral to the management and control of CVD; however, suboptimal adherence impacts health outcomes. This systematic review aims to critically examine interventions targeted at improving medication adherence among persons with CVD in LMICs. Methods: In this systematic review, we searched online databases PubMed, Embase, and CINAHL for studies that evaluated a medication adherence intervention for CVD, reported adherence as an outcome measure, were conducted in LMICs and reported the strategy or tool used to measure adherence. We included articles published in English, available in full text, peer-reviewed, and published between 2010 and 2020. Results: We included 45 articles in this review. The majority of the studies implemented counseling and educational interventions led by nurses, pharmacists, or community health workers. Many of the studies delivered medication-taking reminders in the form of phone calls, text messages, short message services (SMS), and in-phone calendars. Multi-component interventions were more effective than unifocal interventions. Interventions involving technology, such as mobile phone calls, electronic pillboxes, and interactive phone SMS reminders, were more effective than generic reminders. The outcomes reported in the studies varied based on the complexity and combination of strategies. When interventions were implemented at both the patient level, such as reminders, and at the provider level, such as team-based care, the effect on medication adherence was larger. Conclusion: In LMICs, medication adherence interventions among persons with CVD included a combination of patient education, reminders, fixed-dose combination therapy and team-based care approach were generally more effective than singular interventions. Among patients who had CVD, the medication adherence interventions were found to be moderately effective. Future studies focusing on improving medication adherence in LMICs should consider non-physician-led interventions and appropriately adapt the interventions to the local context

Des fractures multiples et brûlures iatrogéniques chez un nouveau-né en raison de l’accouchement non qualifié : Un rapport de cas et documentation

High neonatal mortality is the hallmark of developing countries. Most of the deaths are preventable by good antenatal care with risk identification and access to safe delivery. However, only about a third of births are attended by skilled personnel in Nigeria. The case of a newborn (one of a set of twins) delivered by breech in a church maternity, who sustained multiple fractures and thermal burns from resuscitation is presented. The mother had received antenatal care in an orthodox health facility but opted to deliver in the church maternity. We discuss the problems associated with delivery by unskilled birth attendants while reviewing the literature to highlight the roles and mechanisms of church birth attendants. Reproductive health education for women, their families and communities is advocated to enable birth preparedness. Training, supervision, monitoring and regulation of practice of church birth attendants will also be required to improve outcomes (Afr J Reprod Health 2008; 12[3]:197-206).La haute mortalité néonatale est la marque des pays en voie de développement. La plupart des morts sont évitables par un bon soin prénatal avec de risque identification et accès à un accouchement sans danger. Pourtant, seulement un tiers de naissance s'est occupé par des personnels qualifiés au Nigeria. Est présenté le cas d’un nouveau-né (l’un des jumeaux) accouché par le siège dans une clinique d’accouchement située dans une église, qui a eu des fractures multiples et des brûlures thermiques causées par la réanimation. La mère avait reçu des soins prénatals dans un établissement orthodoxe sanitaire mais avait choisi d’accoucher dans une clinique d’accouchement religieuse. Nous avons discuté les problèmes associés à l’accouchement par les accoucheurs non qualifiés en se documenter afin de mettre en relief les rôles et les mécanismes des accoucheurs religieux. L’éducation de la santé de reproduction pour des femmes, leurs familles et leurs communautés est recommandée afin de permettre la disposition de naissance. L’entrainement, la surveillance, le contrôle et le règlement de la pratique des accoucheurs religieux doivent aussi être requise d’améliorer les resultants (Afr J Reprod Health 2008; 12[3]:197-206)

Cardiac postacute sequelae symptoms of SARS-CoV-2 in community-dwelling adults: cross-sectional study

Objective To examine risk factors for cardiac-related postacute sequelae of SARS-CoV-2 infection (PASC) in community-dwelling adults after acute COVID-19 infection. Methods We performed a cross-sectional analysis among adults who tested positive for COVID-19. Outcomes were self-reported cardiac-related PASC. We conducted stepwise multivariable logistic regression to assess association between the risk factors (existing cardiovascular disease (CVD), pre-existing conditions, days since positive test, COVID-19 hospitalisation, age, sex, education, income) and cardiac-related PASC. Results In a sample of 442 persons, mean (SD) age was 45.4 (16.2) years, 71% were women, 13% were black, 46% had pre-existing conditions, 23% had cardiovascular (CV) risk factors and 4% had CVD. Prevalence of cardiac PASC was 43% and newly diagnosed cardiac conditions were 27%. The odds for cardiac-related PASC were higher among persons with underlying pre-existing conditions (adjusted OR (aOR): 2.00, 95% CI: 1.28 to 3.10) and among those who were hospitalised (aOR: 3.03, 95% CI: 1.58 to 5.83). Conclusions More than a third of persons with COVID-19 reported cardiac-related PASC symptoms. Underlying CVD, pre-existing diseases, age and COVID-19 hospitalisation are possible risk factors for cardiac-related PASC symptoms. COVID-19 may exacerbate CV risk factors and increase risk of complications

Prevalence of Tinea Capitis among Children in Osogbo, Nigeria, and the Associated Risk Factors

Tinea capitis is a fungi infection of the scalp that disproportionately affects children in rural and underserved communities in Nigeria. A case-control study was conducted to identify the causative agents and factors that predispose school pupils to tinea capitis in two selected government-owned public primary schools in Osogbo, Southwestern Nigeria. A total of 230 participants were included in the study: 115 cases and 115 controls. Head scrapings were collected from pupils with suspected T. capitis lesions, viewed under Potassium Hydroxide smear microscopy and cultured in Sabouraud’s Dextrose Agar (SDA) for characteristic fungal elements. A total of 105 (91%) samples were successfully cultured, of which 56% (59/105) were from male pupils. Tricophyton rubrum (34%), Tricophyton mentagrophyte (31%) and Microsporum canis (18%) were the most prevalent organisms. Other dermatophytes obtained include Microsporum nanuum (3%), Epidermophyton floccusum (6%), Tricophyton verucosum (1%), and Microsporum gypseum (8%). Pupils between the ages of 4 and 7 years had the highest distribution (67%) followed by those between the ages of 8 and 11 years (39%). Playing with animals, the sharing of combs and not bathing with soap were significantly associated with tinea capitis infection (P < 0.05) in each case. This study showed a high prevalence of tinea capitis caused by the identified dermatophytes in the area

Subclinical myocardial injury, coagulopathy, and inflammation in COVID-19: A meta-analysis of 41,013 hospitalized patients.

BACKGROUND: Infection with the SARS-CoV-2 virus can lead to myocardial injury, evidenced by increases in specific biomarkers and imaging. OBJECTIVE: To quantify the association between biomarkers of myocardial injury, coagulation, and severe COVID-19 and death in hospitalized patients. METHODS: Studies were identified through a systematic search of indexed articles in PubMed, Embase, CINAHL, Cochrane, Web of Science, and Scopus, published between December 2019 to August 2021. Effect estimates from individual studies for association between markers of myocardial injury (Troponin), myocardial stretch (N-terminal-pro hormone BNP, NT-proBNP), and coagulopathy (D-Dimer) and death or severe/critical COVID-19 were pooled using inverse variance weighted random-effects model. Odds Ratios (OR), Hazard Ratios (HR), and 95% Confidence Intervals (CI) were pooled separately and reported by outcomes of critical/severe COVID-19 and death. A meta-analysis of proportions was also performed to summarize the pooled prevalence of co-morbidities in patients hospitalized with COVID-19. RESULTS: We included 62 articles, with a total of 41,013 patients. The pooled proportion of patients with history of hypertension was 39% (95% CI: 34-44%); diabetes, 21% (95% CI: 18%-24%); coronary artery disease, 13% (95% CI: 10-16%); chronic obstructive pulmonary disease, 7% (95% CI: 5-8%); and history of cancer, 5% (95% CI: 4-7%). Elevated troponin was associated with higher pooled odds of critical/severe COVID-19 and death [Odds Ratio (OR: 1.76, 95% CI: 1.42-2.16)]; and also separately for death (OR: 1.72, 95% CI: 1.32-2.25), and critical/severe COVID-1919 (OR: 1.93, 95% CI: 1.45-2.40). Elevations in NT-proBNP were also associated with higher severe COVID-19 and death (OR: 3.00, 95% CI: 1.58-5.70). Increases in D-dimer levels was also significantly associated with critical/severe COVID-19 and death (pooled OR: 1.38, 95% CI: 1.07-1.79). CONCLUSIONS: This meta-analysis synthesizes existing evidence showing that myocardial injury, and coagulopathy are complications of COVID-19. The durability of these complications and their contributions to long-term cardiac implications of the disease is still being investigated. Patients who have recovered from COVID-19 may benefit from minimally invasive assessment for markers of myocardial injury, stretch and coagulopathy for early risk stratification purposes

Social determinants of hypertension and diabetes among African immigrants: the African immigrants health study.

ObjectiveTo examine the association between social determinants of health, hypertension, and diabetes among African immigrants.MethodsThe African Immigrant Health Study was a cross-sectional study of the health of African immigrants in the Baltimore-Washington Metropolitan Area. The outcomes of interest were self-reported diagnoses of hypertension and diabetes. Logistic regression was used to examine the relationship between educational status, employment, income, social support, health insurance, and self-reported diagnoses of hypertension and diabetes, adjusting for age, sex, and length of stay in the U.S.ResultsA total of 465 participants with mean (±SD) age 47 (±11.5) years were included. Sixty percent were women, 64% had a college degree or higher, 83% were employed, 67% had health insurance, and 70% were married/cohabitating. Over half (60%) of the participants had lived in the United States for ≥ 10 years, and 84% were overweight/obese. The overall prevalence of hypertension and diabetes was 32% and 13%, respectively. The odds of diabetes was higher (aOR: 5.00, 95% CI: 2.13, 11.11) among those who were unemployed than among those who were employed, and the odds of hypertension was higher among those who had health insurance (aOR:1.73, 95% CI: 1.00, 3.00) than among those who did not.ConclusionsAmong African immigrants, those who were unemployed had a higher likelihood of a self-reported diagnosis of diabetes than those who were employed. Also, people who had health insurance were more likely to self-report a diagnosis of hypertension. Additional studies are needed to further understand the influence of social determinants of health on hypertension and diabetes to develop health policies and interventions to improve the cardiovascular health of African immigrants

"Living like an empty gas tank with a leak": Mixed methods study on post-acute sequelae of COVID-19.

BACKGROUND: The burden and presentation of post-acute sequela of SARS-CoV-2 infection (PASC) are a developing major public health concern. OBJECTIVES: To characterize the burden of PASC in community-dwelling individuals and understand the experiences of people living with PASC. METHODS: This mixed-methods study of COVID-19 positive community-dwelling persons involved surveys and in-depth interviews. Main outcome was self-report of possible PASC symptoms 3 weeks or longer after positive COVID-19 test. In-depth interviews were guided by a semi-structured interview guide with open-ended questions and probes based on emerging literature on PASC and the impact of COVID-19. RESULTS: With a survey response rate of 70%, 442 participants were included in this analysis, mean (SD) age 45.4 (16.2) years, 71% female, 12% Black/African American. Compared to those with no PASC symptoms, persons who reported PASC symptoms were more likely to be older (mean age: 46.5 vs. 42; p = 0.013), female (74.3% vs. 61.2%; p = 0.010), to have pre-existing conditions (49.6% vs. 34%; p = 0.005), and to have been hospitalized for COVID-19 (14.2% vs. 2.9%; p = 0.002). About 30% of the participants experienced severe fatigue; the proportion of persons reporting severe fatigue was 7-fold greater in those with PASC symptoms (Adjusted Prevalence Ratio [aPR] 6.73, 95%CI: 2.80-16.18). Persons with PASC symptoms were more likely to report poor quality of life (16% vs. 5%, p<0.001) and worse mental health functioning (Mean difference: -1.87 95%CI: -2.38, -1.37, p<0.001). Themes from in-depth interviews revealed PASC was experienced as debilitating. CONCLUSIONS: In this study, the prevalence of PASC among community-dwelling adults was substantial. Participants reported considerable coping difficulties, restrictions in everyday activities, invisibility of symptoms and experiences, and impediments to getting and receiving PASC care