Application of disease mapping to a global public health issue in low- and middle-income countries : a case study of hypertension.

Background Hypertension is a global public health problem. It is the number one risk factor for mortality and the third leading cause of disability-adjusted life-years (DALYs) worldwide. The burden of the disease is more severe in low- and middle-income countries, where prevalence estimates are projected to increase by 30% over the next decade. This is not surprising owing to the on-going epidemiological transition taking place in these countries, where the interplay between social factors and disease is highly pertinent. However, evidence on the burden of hypertension and its determinants in low- and middle-income countries are limited. The overall aim of this research is to examine the prevalence and status of hypertension in low- and middle-income countries. The definition of hypertension used in this research is blood pressure measurement of ≥140 /90 mmHg (SBP/DBP), the use of antihypertensive medication, or self-reported physician diagnosis of hypertension. Objectives -To estimate the overall prevalence of hypertension in low- and middle-income countries. -To examine the socio-demographic determinants of hypertension in low- and middle-income settings. -To examine the geographic variation of hypertension prevalence in selected low-and middle-income countries. -To interpret the findings and discuss their implications for practice/policy and future research. Methods A systematic review and meta-analysis was conducted to provide overall and regional estimates of hypertension prevalence across low- and middle-income countries, and to examine patterns of the disease across different socio-demographic characteristics in these settings. Studies reporting hypertension prevalence in low- and middle-income countries were sought from electronic databases and grey literature. The data from these studies were analyzed using random-effects meta-analyses and sub-group analyses. Secondary data analyses of DHS datasets were also conducted to estimate hypertension prevalence and examine its geographic variation in selected low- and middle-income countries with hypertension data, while accounting for a number socio-demographic characteristics. The secondary data analyses entailed logistic regression and Bayesian geo-additive analyses. Odds ratios with 95% confidence intervals were reported for the logistic regression analyses, whereas posterior odds ratios with 95% credible intervals were reported for the Bayesian geo-additive analyses. Results The systematic review included 242 studies, comprising 1,494,609 adults from 45 countries. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4–35.3) with the Latin America and Caribbean region reporting the highest prevalence (39.1%, 95% CI 33.1–45.2). Prevalence was also highest in upper-middle income countries (37.8%, 95% CI 35.0–40.6) and lowest in low-income countries (23.1%, 95% CI 20.1–26.2). Prevalence among adults ≥65 years was substantially higher than adults <65 years; however, there was no significant sex-difference overall (31.9% vs 30.8%, p=0.6). Prevalence was generally higher among the non-educated compared to educated people (49.0% vs. 24.9%, p<0.05), among overweight/obese persons compared to normal weight (46.4% vs. 26.3%, p<0.05), and among urban settlers compared to rural (32.7% vs 25.2%, p=0.0005). Meta-regression showed that combined overweight/obesity (p<0.05) and being uneducated (p<0.05) significantly accounted for between-study heterogeneity in hypertension rates The secondary analysis comprised data on 93,247 respondents in 10 selected countries (Albania, Armenia, Azerbaijan, Ukraine, Uzbekistan, Egypt, Morocco, Lesotho, Senegal and Maldives). The prevalence of hypertension was lowest in Morocco (5.4%) and highest in Albania (22.7%). Age was the most consistent predictor of hypertension. Being employed was protective in the Eastern European countries (Albania, Armenia, Azerbaijan, Ukraine and Uzbekistan) (p<0.05 for each) and in African countries such as Egypt and Senegal (p<0.05 for each). Education was protective in Egypt, Senegal and Maldives (p<0.05 for each), but may be a strong determinant in Lesotho given the extremely high literacy rates in the country. Examining the geographic variation of hypertension revealed that Tirana and Elbasan districts had the highest burden of hypertension compared to other districts in Albania; Sharkia and Kalyoubia districts had the highest burden of hypertension compared to other districts in Egypt; while Quthing and Maseru districts had the highest burden of hypertension in Lesotho. Conclusion Overall, the findings provide contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries and evidence that hypertension remains a major public health issue in these settings. The findings also suggest that addressing the wider social determinants of hypertension, such as illiteracy and unemployment, may reduce overall prevalence of the disease in low- and middle-income countries

Passive surveillance of communicable diseases among inmates of Jos central prison, Nigeria

Background: This paper presents a comprehensive study of the disease profile among inmates of Jos prison, Nigeria.  Methods: Blood samples were examined using Giemsa-stained thin and thick smears for Plasmodium parasites determine and stat-pak was employed to detect antibodies against HIV types I and II, sputum samples were stained by Ziehl-Nelson method and examined for acid fast Bacilli. Intestinal parasites were identified and characterized from stool samples using normal saline and lugol’s iodine method and subsequently formal-ether concentration and Kato-katz technique.Results: Out of 132 inmates that presented themselves for medical treatment at the prison clinic, eighty-nine (67.4%) (95% CI=62.4-72.4) were infected with various pathogenic agents, namely Plasmodium parasites (37.1%), intestinal parasites (14.4%), human immunodeficiency virus (11.4%) and Mycobacterium tuberculosis (4.5%). The parasites occurred both as mono and mixed-double and triple infections. Malaria due to Plasmodium falciparum predominates with 65.3% (32/49) while non-falciparum species had 20.4% due to P. malariae (16.3%) and P. vivax (4.1%). Intestinal parasites accounted for 14.4% (95% CI=9.4-19.4) of the infections comprising five species, with Entamoeba hystolytica dorminating (57.9%) and Strogyloides stercoralis rare (4.8%). Of the co-infection, the highest combination was Plasmodium + HIV (35.3%). Fifteen inmates had HIV virus (16.5%) and 6 (6.6%) had Mycobacterium tuberculosis. The age group 1-40 years recorded 93.3% and 100% of the HIV and tuberculosis infections respectively. Eleven deaths were recorded 4 years preceding this survey from various causes including HIV and septicemia.Conclusions: The study concludes that Nigerian prisons pose a serious threat as reservoir of diseases to the nation

Prevalence of the Use of Herbal Medicines among Patients with Cancer: A Systematic Review and Meta-Analysis

Background: Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. )e purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories). Methods: Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta regression analyses were performed to explore source of heterogeneity. Results: In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). )e pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%). Conclusion: Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Schools health promotion among adolescents in Northern Nigeria

Background: Jigawa and Kano States, Northern Nigeria have some of the worst human development outcomes globally for adolescents across a wide range of health indicators. Our aim was to understand health awareness, beliefs, and behaviours of adolescents in school in Jigawa and Kano States, to inform prioritization and development of health promotion interventions in the region. Methods: We carried out a cross-sectional survey followed by focus group discussions (FGDs) with adolescents aged 15 to 20 years from four schools in Jigawa and Kano States (July-August 2019). Adolescents (274 per school) were randomly selected stratified by class-year (SS1 and SS2); 64 participated in FGDs (8 groups of 8). Trained researchers administered a questionnaire face-to-face via smart phones. Topics included: mental health; tobacco use; substance misuse; violence and unintentional injury; physical and dietary behaviours; and hygiene. FGDs investigated topics in greater depth. Here we report prevalence and predictors of mental health calculated from survey responses, and thematic analysis of interview findings. Results: One thousand and seventy-nine students completed the survey (98%);∼50% girls. Preliminary analysis showed prevalence of moderate-severe anxiety was higher in girls than boys (6.8% girls, 0.8% boys, p \u3c 0.001); and moderate-severe depression (10.3% girls, 0.5% boys, p \u3c 0.001). Up to 50% boys and girls experienced violence or abuse in school, and 16% used a prescription drug without a prescription in past 30 days. Multivariable logistic regression showed female gender (aOR =4.0, 95% CI; 2.7,6.0); 30-day off-prescription drug use - aOR=2.3 (1.5,3.8); and being hit or slapped by a teacher - aOR=1.7, (1.1, 2.6) were predictors of moderate to severe anxiety. Results were similar for moderate to severe depression. Qualitative findings supported and contextualized these results. Conclusions: Results will inform school-based interventions to improve health of adolescents in the region. Key messages: Administering a health questionnaire to gather health information of adolescents in school in Kano and Jigawa states, Nigeria was feasible. Health questionnaire and focus group data will be shared with school and community leaders to shape school-based interventions to improve health outcomes amongst adolescents

Passive surveillance of communicable diseases among inmates of Jos central prison, Nigeria

Background: This paper presents a comprehensive study of the disease profile among inmates of Jos prison, Nigeria. Methods: Blood samples were examined using Giemsa-stained thin and thick smears for Plasmodium parasites determine and stat-pak was employed to detect antibodies against HIV types I and II, sputum samples were stained by Ziehl-Nelson method and examined for acid fast Bacilli. Intestinal parasites were identified and characterized from stool samples using normal saline and lugol's iodine method and subsequently formal-ether concentration and Kato-katz technique. Results: Out of 132 inmates that presented themselves for medical treatment at the prison clinic, eighty-nine (67.4%) (95% CI=62.4-72.4) were infected with various pathogenic agents, namely Plasmodium parasites (37.1%), intestinal parasites (14.4%), human immunodeficiency virus (11.4%) and Mycobacterium tuberculosis (4.5%). The parasites occurred both as mono and mixed-double and triple infections. Malaria due to Plasmodium falciparum predominates with 65.3% (32/49) while non-falciparum species had 20.4% due to P. malariae (16.3%) and P. vivax (4.1%). Intestinal parasites accounted for 14.4% (95% CI=9.4-19.4) of the infections comprising five species, with Entamoeba hystolytica dorminating (57.9%) and Strogyloides stercoralis rare (4.8%). Of the co-infection, the highest combination was Plasmodium + HIV (35.3%). Fifteen inmates had HIV virus (16.5%) and 6 (6.6%) had Mycobacterium tuberculosis. The age group 1-40 years recorded 93.3% and 100% of the HIV and tuberculosis infections respectively. Eleven deaths were recorded 4 years preceding this survey from various causes including HIV and septicemia. Conclusions: The study concludes that Nigerian prisons pose a serious threat as reservoir of diseases to the nation. [Int J Res Med Sci 2016; 4(5.000): 1366-1374

Knowledge about sickle cell disease.

BackgroundSickle cell disease (SCD) is one of the most frequent and traumatizing genetic disease in Uganda, with the prevalence of the sickle cell trait (SCT) estimated at 13.3% leading to serious psycho-social and economic impact on the patients and their families.AimThis study aimed to determine the burden of SCT and factors influencing the uptake of screening services among secondary school students in Uganda.MethodsWe used an analytical cross-sectional design with a multi-stage sampling approach. A total of 399 students from four secondary schools in Kampala City were enrolled in this study. Data were gathered using semi-structured questionnaires and blood screening. We used the sickling test to determine the presence of sickle cell alleles among the participants and hemoglobin electrophoresis as a confirmatory test. Data gathered using the questionnaire were analyzed using descriptive and inferential statistics.ResultsIn total, 5.8% of participants who were tested during this study had SCT. Most (80.2%) participants were not in an intimate relationship at the time of data collection. The majority (60.4%) had moderate knowledge about SCT screening and obtained information about screening from the school. Only 29 (7.3%) participants knew of a family member with sickle cell. Overall, participants had a negative attitude toward SCT screening (67%), although 41.6% believed that most people who were sickle cell carriers did not live long and were often sick. Statistically significant associations were found between testing for SCT and knowing a partner’s sickle cell status (odds ratio [OR] 2.112, p = 0.043) and Anglican religion (OR 2.075, p = 0.047).ConclusionDespite the moderate level of knowledge and negative attitudes, a relatively large number of participants had SCT. This highlights the need for a comprehensive health education package targeting adolescents to promote SCD/SCT screening.</div

Attitude of secondary school students about SCT screening.

Attitude of secondary school students about SCT screening.</p

Questionnaire.

BackgroundSickle cell disease (SCD) is one of the most frequent and traumatizing genetic disease in Uganda, with the prevalence of the sickle cell trait (SCT) estimated at 13.3% leading to serious psycho-social and economic impact on the patients and their families.AimThis study aimed to determine the burden of SCT and factors influencing the uptake of screening services among secondary school students in Uganda.MethodsWe used an analytical cross-sectional design with a multi-stage sampling approach. A total of 399 students from four secondary schools in Kampala City were enrolled in this study. Data were gathered using semi-structured questionnaires and blood screening. We used the sickling test to determine the presence of sickle cell alleles among the participants and hemoglobin electrophoresis as a confirmatory test. Data gathered using the questionnaire were analyzed using descriptive and inferential statistics.ResultsIn total, 5.8% of participants who were tested during this study had SCT. Most (80.2%) participants were not in an intimate relationship at the time of data collection. The majority (60.4%) had moderate knowledge about SCT screening and obtained information about screening from the school. Only 29 (7.3%) participants knew of a family member with sickle cell. Overall, participants had a negative attitude toward SCT screening (67%), although 41.6% believed that most people who were sickle cell carriers did not live long and were often sick. Statistically significant associations were found between testing for SCT and knowing a partner’s sickle cell status (odds ratio [OR] 2.112, p = 0.043) and Anglican religion (OR 2.075, p = 0.047).ConclusionDespite the moderate level of knowledge and negative attitudes, a relatively large number of participants had SCT. This highlights the need for a comprehensive health education package targeting adolescents to promote SCD/SCT screening.</div