Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)

Abstract Background: Few studies have characterized epidemiology and management of hypertension across several communities with comparable methodology in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. We collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using digital blood pressure monitors and following a standardized protocol. We estimated 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness and treatment. Results: We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked, and 32·7% were overweight/obese. A quarter of the participants (25·1% had hypertension, half of whom (57·6%) were diagnosed. Among diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% Interquartile range, IQR (2·4%, 10·3%) and 13·2% had risk of 20% or greater while 7·1% had risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of adults had hypertension, about 40% were unaware, half of those aware were treated and half of those treated were controlled blood pressure. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (SevenCEWA)

BMC Public Health ◽

10.1186/s12889-020-09829-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F. Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment. Results We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4%) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of > 30%. Conclusion In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)

10.21203/rs.3.rs-25100/v2 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

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Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)

10.21203/rs.3.rs-25100/v1 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background Few studies have characterized epidemiology and management of hypertension across several communities with comparable methodology in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods Between June and August 2018, we conducted household surveys in 7 communities in Kenya, Nigeria, Tanzania, and Uganda and collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using a standardized protocol and digital monitors. We estimated 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fit hierarchical models to identify determinants of hypertension prevalence, awareness and treatment. Results We analyzed data of 3549 participants with a mean age of 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked, and 32·7% were overweight/obese. A quarter (901, 25·1% (95% Confidence Interval 23·7%, 26·6%)) of participants had hypertension, half of whom (515, 57·6%) were diagnosed. Among diagnosed, 50·5% (260) were taking medication, and among those taking medication 47·3%(123) were controlled. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% Interquartile range, IQR (2·4%, 10·3%) and 13·2% had risk of 20% or greater while 7·1% had risk of > 30%. Conclusion In seven communities in east and west Africa, a quarter of adults had hypertension, about 40% were unaware, half of those aware were treated and half of those treated were controlled blood pressure. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)

10.21203/rs.3.rs-25100/v3 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background: Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment. Results: We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4 %) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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P1946Hypertension prevalence, awareness, treatment and control and 10-year estimated CVD risk in East and West Africa: pooled analysis of data from 4 African countries

European Heart Journal ◽

10.1093/eurheartj/ehz748.0693 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O Samson ◽

A Muhihi ◽

S Mohamed ◽

S Ameh ◽

C Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

West Africa ◽

Health Care Facilities ◽

Community Dwelling ◽

Sub Saharan Africa ◽

African Countries ◽

Cvd Risk ◽

Anthropometric Measures ◽

East And West ◽

And Control

Abstract Background Though the prevalence of hypertension is rising in Sub-Saharan Africa, few studies have characterized the epidemiology and management of hypertension across many heterogeneous communities. We assessed prevalence, awareness, treatment and control of hypertension and estimated the 10-year cardiovascular risk across six sites in East and West Africa. Methods Between June and August 2018, we conducted household-based surveys in 6 rural, semi-urban and urban settings in Kenya, Nigeria, Tanzania and Uganda to enroll community-dwelling adults (aged >18 years) collect data including age, gender, smoking, anthropometric measures, health insurance, utilization of health care facilities. We defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use. We used country specific Globorisk prediction equations to estimate 10-year CVD risk. Results A total 3,150 participants with a mean age of 40 years (SD 15), 61% of whom were women, 8% had ever smoked, and 33% were overweight/obese. About 23.7% (95% CI 22.2, 25.2) of the entire sample had hypertension, of whom 60.6% (56.8, 64.3) were diagnosed. Among diagnosed, 61.7% (57.2, 66.1) were taking antihypertensives, and 27.7% (22.7, 33.1) had controlled BP. The prevalence of hypertension was 38.6% in Ikire-Nigeria, 25.1% Ukonga-Tanzania, 23.3% in Oyo-Nigeria, 21.6% in Okpok-Nigeria, 20.4% in Soroti-Uganda, and 9.7% in Viwandani-Kenya. The overall median estimated 10-yr CVD risk was low 4.6% IQR (2.3, 9.6) and 8.6% had 10-yr CVD risk >10%. (Figure 1) Conclusion Among African adults aged >18 years, nearly a quarter have hypertension, three in 5 being treated, and fewer than three in ten had BP under control. The low number of people in control is ubiquitous in all sites and warrants greater prevention strategies, better screening and more effective and affordable treatment options than what is currently available.

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Cardiovascular Disease Healthcare Utilization in Sub-Saharan Africa: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030419 ◽

2019 ◽

Vol 16 (3) ◽

pp. 419 ◽

Cited By ~ 3

Author(s):

Herbert Chikafu ◽

Moses Chimbari

Keyword(s):

Cardiovascular Disease ◽

Healthcare Utilization ◽

Hospital Admissions ◽

Stroke Care ◽

Sub Saharan Africa ◽

Quantitative Methodology ◽

Healthcare Provision ◽

Cvd Risk ◽

Epidemiological Transitions ◽

Sub Saharan

Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008–2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.

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Grey relational evaluation of impact and control of malaria in Sub-Saharan Africa

Grey Systems Theory and Application ◽

10.1108/gs-06-2019-0020 ◽

2019 ◽

Vol 9 (4) ◽

pp. 415-431 ◽

Cited By ~ 4

Author(s):

Tawiah Kwatekwei Quartey-Papafio ◽

Sifeng Liu ◽

Sara Javed

Keyword(s):

West Africa ◽

Malaria Incidence ◽

Control Measures ◽

Sub Saharan Africa ◽

Content Type ◽

Independent States ◽

Sub Saharan ◽

And Control ◽

Grey Relational ◽

The Impact

Purpose The rise in malaria deaths discloses a decline of global malaria eradication that shows that control measures and fund distribution have missed its right of way. Therefore, the purpose of this paper is to study and evaluate the impact and control of malaria on the independent states of the Sub-Saharan African (SSA) region over the time period of 2010–2017 using Deng’s Grey incidence analysis, absolute degree GIA and second synthetic degree GIA model. Design/methodology/approach The purposive data sampling is a secondary data from World Developmental Indicators indicating the incidence of new malaria cases (per 1,000 population at risk) for 45 independent states in SSA. GIA models were applied on array sequences into a single relational grade for ranking to be obtained and analyzed to evaluate trend over a predicted period. Findings Grey relational analysis classifies West Africa as the highly infectious region of malaria incidence having Burkina Faso, Sierra Leone, Ghana, Benin, Liberia and Gambia suffering severely. Also, results indicate Southern Africa to be the least of all affected in the African belt that includes Eswatini, Namibia, Botswana, South Africa and Mozambique. But, predictions revealed that the infection rate is expected to fall in West Africa, whereas the least vulnerable countries will experience a rise in malaria incidence through to the next ten years. Therefore, this study draws the attention of all stakeholders and interest groups to adopt effective policies to fight malaria. Originality/value The study is a pioneer to unravel the most vulnerable countries in the SSA region as far as the incidence of new malaria cases is a concern through the use of second synthetic GIA model. The outcome of the study is substantial to direct research funds to control and eliminate malaria.

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High Blood Pressure in Sub-Saharan Africa: Why Prevention, Detection, and Control are Urgent and Important

Journal of Clinical Hypertension ◽

10.1111/jch.12599 ◽

2015 ◽

Vol 17 (9) ◽

pp. 663-667 ◽

Cited By ~ 12

Author(s):

Norm R.C. Campbell ◽

Pascal Bovet ◽

Aletta Elisabeth Schutte ◽

Daniel Lemogoum ◽

Armand Seraphin Nkwescheu

Keyword(s):

Blood Pressure ◽

High Blood Pressure ◽

Sub Saharan Africa ◽

Sub Saharan ◽

And Control

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Cardiovascular disease: the new epidemic in sub-Saharan Africa

Vascular ◽

10.1258/vasc.2011.ra0049 ◽

2011 ◽

Vol 19 (6) ◽

pp. 301-307 ◽

Cited By ~ 16

Author(s):

Ifechukwude Ikem ◽

Bauer E Sumpio

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Sub Saharan Africa ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Double Burden ◽

The Usa ◽

Acquired Immunodeficiency ◽

Sub Saharan ◽

Immunodeficiency Syndrome

Sub-Saharan Africa (SSA) is now facing a double burden of disease where patients are suffering from non-communicable diseases such as coronary heart disease, along with the burden of the current human immunodeficiency virus (HIV) epidemic. Due to this double burden, cardiovascular disease (CVD) prevention and treatment has been overlooked, allowing the rates to continue to rise unchecked. A series of searches were conducted using PubMed as the primary database. From these searches, journal articles were compiled that related to diabetes, obesity and smoking rates in SSA. Also, the prevalence of CVD in the USA was reviewed. Although the USA has higher rates of CVD now, the rates were on the decline compared with SSA. Due to ‘Westernization’ of SSA, the rates of CVD risk factors, such as diabetes, are expected to increase by 50%. Because of this, 80% of CVD deaths worldwide took place in developing countries like those in SSA. Although HIV/acquired immunodeficiency syndrome (AIDS) is the current epidemic in SSA, CVD disease poses a threat as the new epidemic because of the increasing rates of these CVD risk factors. Without combating this disease now, SSA is facing an epidemiological shift from AIDS to CVD being the leading cause of death.

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