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

Impact of Insecticide Treated Nets and Intermittent Preventive Treatment in Reducing Malaria Morbidity among Pregnant Women in Gombe, Nigeria

Malaria in pregnancy is a major public health problem affecting women fetuses and new borns.. Many studies highlight the critical importance of continuing the use of Insecticide Treated Nets (ITN) and Intermittent Preventive Treatment In Pregnancy (IPTp) among pregnant women to reduce the adverse consequences of malaria in pregnancy. This study was conducted in order to determine malaria prevalence in relation to the use of ITN and IPTp among the pregnant women in the study area. Five (5) ml of blood was obtained from each participant by the use of a sterile syringe and placed in a sterile EDTA container for laboratory analysis. The malaria parasite was detected by microscopic examination of Giemsa-stained thick blood films. Information on the use of ITN and IPTP was collected using administered questionnaire. A high prevalence of 78.4% was observed among the studied population. Although 74.4% of those that use ITN were positive for malaria parasite as against the 83.6% of those that reported not using the ITN, the difference was statistically not significant (p&lt;0.05). 70.0% of those reported using IPTp were positive however, higher percentage was observed for those reported not using IPTp (83.7.0%). The difference was statistically significant in this case. This study has shown the influence of malaria prevention method during pregnancy on malaria infection and the need for targeted preventive starategies when designing and implementing policies aimed at improving uptake of these measures during pregnancy in Gombe

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

Acute Toxicity Study and Hepatocurative Effect of Aqueous Stem Bark Extract of Parkia Biglobosa in Wister albino Rats

Parkia biglobosa plant is widely is used in folk medicinal practices to treat and/or manage various diseases including diabetes, malaria, diarrhea and pains. The current research seek to establish the toxicity profile and hepatocurative ability of aqueous stem bark extract of the plant. Twelve (12) rats were used for Oral LD50 determination, and were grouped into four (4) groups of three rats (3) each. The first three groups were administered with 10 mg/kg, 100 mg/kg and 1000 mg/kg body weight of the extract respectively, while the last group was subdivided into three groups of one rat each and were administered with 2500mg/kg, 3500mg/kg and 5000mg/kg body weight of the extract respectively. For the hepatocurative studies, twenty five (25) experimental rats were divided into five groups of five (5) rats each. Group I served as normal rats, Group II served as test Control while Groups III to V were induced with liver damage and administered with 50mg/kg, 100mg/kg and 150mg/kg of the extract respectively. The LD50 was found to be greater than 5000mg/kg, while phytochemical screening revealed the presence of Flavanoids, Glycosides, Tanins, Saponins, Steroids and Phenols, with the absence of Anthraquinones. For the hepatocurative study, a significant (p&lt;0.0.5) increase in serum albumin and liver enzymes (AST, ALT and ALP) was observed in test control compared to normal control. Upon administration of the extract, a significant (p&lt;0.0.5) fall in Albumin, AST, ALT and ALP was recorded in a dose dependent pattern. No significant difference (p&gt;0.05) was observed between groups in total protein, direct and total bilirubin. The research concludes that the extract is practically non-toxic and possess strong hepatocurative ability which might be due to the phytochemicals present. Keywords: Acute toxiicity; CCl4; Liver; P. biglobosa; Phytochemical and wistar rats. DOI: 10.7176/JNSR/13-16-04 Publication date:September 30th 202

Relatives from Hereditary Breast and Ovarian Cancer and Lynch Syndrome Families Forgoing Genetic Testing: Findings from the Swiss CASCADE Cohort.

Cascade genetic testing of relatives from families with pathogenic variants associated with hereditary breast and ovarian cancer (HBOC) or Lynch syndrome (LS) has important implications for cancer prevention. We compared the characteristics of relatives from HBOC or LS families who did not have genetic testing (GT (-) group) with those who had genetic testing (GT (+) group), regardless of the outcome. Self-administered surveys collected cross-sectional data between September 2017 and December 2021 from relatives participating in the CASCADE cohort. We used multivariable logistic regression with LASSO variable selection. Among n = 115 relatives who completed the baseline survey, 38% (n = 44) were in the GT (-) group. Being male (OR: 2.79, 95% CI: 1.10-7.10) and without a previous cancer diagnosis (OR: 4.47, 95% CI: 1.03-19.42) increased the odds of being untested by almost three times. Individuals from families with fewer tested relatives had 29% higher odds of being untested (OR: 0.71, 95% CI: 0.55-0.92). Reasons for forgoing cascade testing were: lack of provider recommendation, lack of time and interest in testing, being afraid of discrimination, and high out-of-pocket costs. Multilevel interventions designed to increase awareness about clinical implications of HBOC and LS in males, referrals from non-specialists, and support for testing multiple family members could improve the uptake of cascade testing

Intention to Inform Relatives, Rates of Cascade Testing, and Preference for Patient-Mediated Communication in Families Concerned with Hereditary Breast and Ovarian Cancer and Lynch Syndrome: The Swiss CASCADE Cohort.

Cascade screening for Tier 1 cancer genetic conditions is a significant public health intervention because it identifies untested relatives of individuals known to carry pathogenic variants associated with hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS). The Swiss CASCADE is a family-based, open-ended cohort, including carriers of HBOC- and LS-associated pathogenic variants and their relatives. This paper describes rates of cascade screening in relatives from HBOC- and LS- harboring families, examines carriers' preferences for communication of testing results, and describes theory-based predictors of intention to invite relatives to a cascade screening program. Information has been provided by 304 index cases and 115 relatives recruited from September 2017 to December 2021. On average, 10 relatives per index case were potentially eligible for cascade screening. Approximately 65% of respondents wanted to invite relatives to the cohort, and approximately 50% indicated a preference for patient-mediated communication of testing results, possibly with the assistance of digital technology. Intention to invite relatives was higher for first- compared to second- and third-degree relatives, but was not different between syndromes or based on relatives' gender. The family environment and carrying pathogenic variants predicts intention to invite relatives. Information helps optimize delivery of tailored genetic services

Investigation of livestock for presence of Trypanosoma brucei gambiense in Tafa Local Government Area of Niger State, Nigeria

The study investigated the presence of Trypanosoma brucei gambiense in livestock to ascertain their reservoir role and also screened for other pathogenic trypanosomes of animals in Tafa Local Government Area of Niger state, Nigeria. A total of 460 livestock comprising (cattle, sheep, goats, and dogs) selected at random were bled, examined using the buffy coat and Giemsa stained thin film and packed cell volume estimated. Questionnaire was filled for each animal on demography, awareness and management practices. An overall prevalence of 2.17% with Trypanosoma brucei, T. congolense, T. vivax and a mixed infection of T. brucei and T. congolense observed microscopically awaiting characterization. Interviews revealed high awareness (82.8%) of tsetse and trypanosomiasis described as bush disease and abortion in four cows. The PCV values were within the normal range, however, a significant decrease (P&lt;0.05) was observed in sheep aged 7months to 4years in two communities. Therefore, the study indicated the presence of T. brucei and other trypanosomes suggesting that animal trypanosomiasis is still a problem to animal health and wellbeing in the study area. The study recommends effective integrated chemotherapy and vector control including livestock rearing under intensive management system to boost livestock production and productivity

Pim1 promotes human prostate cancer cell tumorigenicity and c-MYC transcriptional activity

<p>Abstract</p> <p>Background</p> <p>The serine/threonine kinase PIM1 has been implicated as an oncogene in various human cancers including lymphomas, gastric, colorectal and prostate carcinomas. In mouse models, Pim1 is known to cooperate with c-Myc to promote tumorigenicity. However, there has been limited analysis of the tumorigenic potential of Pim1 overexpression in benign and malignant human prostate cancer cells <it>in vivo</it>.</p> <p>Methods</p> <p>We overexpressed Pim1 in three human prostate cell lines representing different disease stages including benign (RWPE1), androgen-dependent cancer (LNCaP) and androgen-independent cancer (DU145). We then analyzed <it>in vitro </it>and <it>in vivo </it>tumorigenicity as well as the effect of Pim1 overexpression on c-MYC transcriptional activity by reporter assays and gene expression profiling using an inducible MYC-ER system. To validate that Pim1 induces tumorigenicity and target gene expression by modulating c-MYC transcriptional activity, we inhibited c-MYC using a small molecule inhibitor (10058-F4) or RNA interference.</p> <p>Results</p> <p>Overexpression of Pim1 alone was not sufficient to convert the benign RWPE1 cell to malignancy although it enhanced their proliferation rates when grown as xenografts <it>in vivo</it>. However, Pim1 expression enhanced the <it>in vitro </it>and <it>in vivo </it>tumorigenic potentials of the human prostate cancer cell lines LNCaP and DU145. Reporter assays revealed increased c-MYC transcriptional activity in Pim1-expressing cells and mRNA expression profiling demonstrated that a large fraction of c-MYC target genes were also regulated by Pim1 expression. The c-MYC inhibitor 10058-F4 suppressed the tumorigenicity of Pim1-expressing prostate cancer cells. Interestingly, 10058-F4 treatment also led to a reduction of Pim1 protein but not mRNA. Knocking-down c-MYC using short hairpin RNA reversed the effects of Pim1 on Pim1/MYC target genes.</p> <p>Conclusion</p> <p>Our results suggest an <it>in vivo </it>role of Pim1 in promoting prostate tumorigenesis although it displayed distinct oncogenic activities depending on the disease stage of the cell line. Pim1 promotes tumorigenicity at least in part by enhancing c-MYC transcriptional activity. We also made the novel discovery that treatment of cells with the c-MYC inhibitor 10058-F4 leads to a reduction in Pim1 protein levels.</p