May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Mpilo Outcomes for Stroke Study (MOSS): Does taking antihypertensives prior to stroke affect mortality during acute stroke admissions?

AbstractObjectiveTo assess if taking outpatient antihypertensives prior to stroke onset influences acute stroke inpatient mortality.DesignRetrospective chart review of 417 adults admitted for acute stroke from January 2013 to December 2014.SettingSingle tertiary hospital in Zimbabwe.ParticipantsOf the 417 adult patients admitted with stroke, 40 were excluded (2 rheumatic heart disease, 10 transient ischemic attacks, and 28 incomplete documentation).MethodsStudy registry was obtained from acute stroke billing codes in the hospital database and SPSS 23 was used for analysis.Primary and secondary outcomes and measuresInpatient mortality was the primary outcome and determination of reported outpatient antihypertensive regimens was the secondary outcome.ResultsAmong the 377 patients in the final analysis the mean age was 65.8 ± 15.7 years, 64.5% were female, 68.9% had known hypertension, and 51.2% were taking outpatient antihypertensives. Overall inpatient mortality was 134 (35.5%, 95 CI: 30.6 -39.6). Mortality was similar among patients taking and not taking outpatient antihypertensives, 39.2% and 31.5% respectively (X2test, p=0.4; 95 CI 31.3-40.3). Four most common antihypertensive regimens were: calcium channel blocker/thiazides dual therapy, thiazide monotherapy, calcium channel blocker monotherapy, and calcium channel blocker/ angiotensin converting enzyme inhibitor or angiotensin receptor blocker dual therapy.Conclusions and RelevanceOnly half of the patients admitted for stroke were taking antihypertensives prior to stroke onset. There was no statistical significance in inpatient mortality associated with taking antihypertensives prior to developing stroke, suggesting either the limited impact of outpatient antihypertensives on in-hospital mortality or low outpatient antihypertensive adherence.Strengths and Limitations of the StudyWe studied a large group of patients at a major safety net center in a region of Zimbabwe that is chronically under-represented in stroke studiesThe degree of outpatient hypertension control among patients on antihypertensives could not be determined due to lack of access to outpatient recordsPoor medical knowledge, altered mental status from stroke, and the absence of an integrated outpatient pharmacy database limited accurate medication reconciliationsLack of neuroimaging data limited the ability to discern between ischemic versus hemorrhagic strokes and rule out structural stroke mimics such as intracranial tumorsInconsistent and incomplete documentation practices such as omission of vital sign documentation on admission limited data collectionFunding StatementThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.Competing InterestsNone of the authors have any competing interests to declare.Statement of Ethics ApprovalThis research was approved by the ethics body of Mpilo Central Hospital on 21 June 2016 as part of the mandate to assess The Burden of Hypertension and its Co-morbidities in Patients Admitted at Mpilo Central Hospital.</jats:sec

May Measurement Month 2021: an analysis of blood pressure screening results from Zimbabwe

The May Measurement Month 2021 campaign in Zimbabwe was aimed at assessing the frequency of hypertension and improving awareness among the population of the sequelae of elevated blood pressure (BP). Participants aged 18 years and above were recruited at outdoor booths to fill out a questionnaire and provide three BP measurements with 1-min intervals. Of the 2094 participants, over one-third (37.3%) were hypertensive, half of hypertensives (49.7%) were aware they had elevated pressure, and less than half (45.0%) of the hypertensive patients were on antihypertensive medications. Increasing age was directly proportional to hypertension with a large leap from 9.5 to 27.7% between the 18-29 and 30-39 age groups. Hypertension remains a major public health challenge in Zimbabwe. Improving access to preventive health screening services as well as treatment facilities is essential to early detect and control hypertension

Massive hemoptysis and complete unilateral lung collapse in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome: a case report

BACKGROUND: We report an extremely rare case of massive hemoptysis and complete left-sided lung collapse in pregnancy due to pulmonary tuberculosis in a health care worker with good maternal and fetal outcome. CASE PRESENTATION: A 33-year-old human immuno deficiency virus seronegative African health care worker in her fourth pregnancy with two previous second trimester miscarriages and an apparently healthy daughter from her third pregnancy presented coughing up copious amounts of blood at 18 weeks and two days of gestation. She had a cervical suture in situ for presumed cervical weakness. Computed tomography of her chest showed complete collapse of the left lung; subsequent bronchoscopy was apparently normal. Her serum β-human chorionic gonadotropin, tests for autoimmune disease and echocardiography were all normal. Her lung re-inflated spontaneously. Sputum for acid alcohol fast bacilli was positive; our patient was commenced on anti-tuberculosis medication and pyridoxine. At 41 weeks and three days of pregnancy our patient went into spontaneous labor and delivered a live born female baby weighing 2.6 kg with APGAR scores of nine and 10 at one and five minutes respectively. She and her baby are apparently doing well about 10 months after delivery. CONCLUSION: It is possible to have massive hemoptysis and complete unilateral lung collapse with spontaneous resolution in pregnancy due to pulmonary tuberculosis with good maternal and fetal outcome

Remote Learning and Teaching in Southern Africa: A Case Study of Health Professions Education Institutions

Abstract Background Southern Africa, like other parts of the world, has always strived to deliver quality health professions education. These efforts have been influenced to a larger extent by the socio-economic and cultural context of the region, but also by what happens globally. The global disruption caused by the COVID-19 pandemic necessitated the implementation of emergency remote teaching (ERT) to continue delivering on the mandate of educating future health professionals in 2020. The purpose of this research was to describe the change process through which selected health professions education institutions (HPEIs) in the Southern African region adjusted their academic programmes for remote learning and teaching during the COVID-19 related pandemic. Methods A mixed methods study with a case study design was applied using the ADKAR model as a conceptual framework for data interpretation. The study population consisted of educators, students, and administrators in undergraduate medical and nursing programmes from six institutions in five countries. Results A total of 1,307 respondents provided data for the study. Many of the institutions were caught off-guard when most educators and almost all students were required to leave their universities and go into isolation at home. Stakeholders immediately became aware of the need to adopt online approaches as an emergency measure. In all programmes, educators, students, and administrators agreed that they should change and wanted to change, and some students realised that they had to take charge of their own learning independently. Overall educators reported confidence with the use of standard Microsoft software, while knowledge of learning management systems proved more challenging for both educators and students. Many stakeholders, especially students and administrators, reported uncertainty about their ability to function in the new reality. Conducive family dynamics, a quiet space to study, good connectivity, a reliable electricity supply and appropriate devices were reported to reinforce learning and teaching. Conclusions The findings highlight the need to scale up educational infrastructure, prioritise strategic directives, drive continuous professional development of educators and foster co-constructivist approaches towards student centered education, including formal online learning.</jats:p

Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach

Background The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask–wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. Objective This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. Methods A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. Results Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. Conclusions This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. International Registered Report Identifier (IRRID) DERR1-10.2196/28905 </jats:sec

Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach (Preprint)

BACKGROUND The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask–wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. OBJECTIVE This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. METHODS A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. RESULTS Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. CONCLUSIONS This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/28905 </sec

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Abstract Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk. </jats:sec