scholarly journals Cardiomyopathies in Sub-Saharan Africa: Hypertensive Heart Disease (Cardiomyopathy), Peripartum Cardiomyopathy and HIV-Associated Cardiomyopathy

10.5772/67023 ◽  
2017 ◽  
Author(s):  
Okechukwu S. Ogah ◽  
Ayodele O. Falase
Keyword(s):  
Heart Disease ◽  
Hypertensive Heart Disease ◽  
Peripartum Cardiomyopathy ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals The Spectrum of heart disease among adults at the Bamenda Regional Hospital, North west Cameroon: a semi urban setting

2019 ◽  
Author(s):  
Manuel Ndo Akono ◽  
Larissa Pone Simo ◽  
Valirie Ndip Agbor ◽  
Sylvain Laah Njoyo ◽  
Dora Mbanya
Keyword(s):  
Heart Disease ◽  
Significant Proportion ◽  
Hypertensive Heart Disease ◽  
Regional Hospital ◽  
Urban Setting ◽  
Sub Saharan Africa ◽  
North West ◽  
The North ◽  
Study Population ◽  
Sub Saharan

Abstract Background Non-communicable diseases are the leading causes of global mortality, and the second commonest cause in sub-Saharan Africa. They have been projected to drive mortality in sub-Saharan Africa by 2030. Methods This is a chart review of echocardiographic records of adult patients of the Imagery Centre of the Bamenda Regional Hospital in the North West Region of Cameroon. Data was collected for the period between July 2015 and April 2018, and included age, sex, comorbidities, ejection fraction and echocardiographic findings. Results In total, 673 records were included in our study, of which 506 had a definite heart disease. Amongst those with a definite heart disease, 93 had mixed cardiopathies. Their ages ranged from 18 – 105 years with a median age of 64.0 (Interquartile range [IQR] = 47 – 75) years. Females accounted for a greater proportion (55.3%) of the study population. The most common echocardiographic diagnoses were hypertensive heart disease (41.1%), valvular heart disease (22.3%) and cardiomyopathies (11.4%). The prevalence of heart failure was 17.5%, with hypertensive heart disease being the leading cause. Conclusion Hypertensive heart disease is the most common heart disease in this semi-urban
setting in Cameroon. A significant proportion of the population has more than one heart disease (mixed cardiopathies).

scholarly journals Establishing Cutoffs for Streptococcal Antibody Titers in Uganda: Implications for Rheumatic Fever Diagnosis

2019 ◽  
Author(s):  
Emmy Okello ◽  
Meghna Murali ◽  
Joselyn Rwebembera ◽  
Jenifer Atala ◽  
Nada Harik ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Normal Values ◽  
Sub Saharan Africa ◽  
Age Group ◽  
Upper Limit ◽  
Antibody Titers ◽  
Sub Saharan ◽  
Rheumatic Heart

AbstractBackgroundCentral to rheumatic fever (RF) diagnosis is evidence of streptococcal exposure, specifically antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies. It is unknown if these antibody titers should be adjusted to the background exposure rates of GAS or if published standards should be used. Here, we establish the normal values of ASO and ADB in Uganda and examine RF case detection using published vs. population-specific thresholds.MethodsParticipants (age 0-50 years) were recruited. ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for ADB determination by enzyme inhibition assay, andthe 80% upper limit values by age were established. The published standard values for ASO (200IU/ml) and ADB (375IU/ml) were compared to the Ugandan 80% upper limit of normal values (ULN) for RF case detection in children 5-15 years.FindingsOf the 428 participants, 16 were excluded from analysis (9 sore throat, 1 skin sores, 5 fever, 4 echocardiograms showing occult RHD), and 183 of the remaining were children 5-15 years. The median ASO titer in this age group was 220 IU/ml, with the 80th percentile value of 389 IU/ml. The median ADB titer in this age group was 375 IU/ml, with the 80th percentile value of 568 IU/ml. Application of new Ugandan cutoffs to 528 children enrolled in our prospective RF study, reduced the number of definite RF cases to 120/528 (22·7%), as compared to 173/528 (32·8%) using published normal values.InterpretationThe 80th percentile ULN for ASO and ADB are higher in Uganda than in other countries. Applying these higher values to RF diagnosis in Uganda results in higher diagnostic specificity, but some unknown loss in sensitivity. Implications of over-diagnosis and missed cases will be explored through a longitudinal follow-up study of children in the RF research program.FundingThis work was supported by American Heart Association Grant #17SFRN33670607 / Andrea Beaton / 2017 and DELTAS Africa Initiative.Research in contextEvidence before this studyWe searched PubMed for data on normal values of streptococcal antibody titers within diverse populations between database inception and January 1, 2019, using the search terms (rheumatic fever) OR (streptococcal antibodies). Nine studies were identified, but only one was from sub-Saharan Africa (2018, Ethiopia) and it was limited by vague exclusion criteria and lack of data on anti-DNase B. Given the high burden of rheumatic heart disease in sub-Saharan Africa, further data is needed to determine normal streptococcal antibody titers in this population and to assess the clinical impact of different cutoffs for RF diagnosis.Added value of this studyOur study utilized a rigorous approach to exclude patients with history of recent possible streptococcal exposure including skin and throat infection and employed echocardiography to exclude patients with pre-existing rheumatic heart disease. Additionally, this study was conducted in parallel to a larger epidemiological cohort study of rheumatic fever in Uganda, allowing us, for the first time, to prospectively determine how utilization of different streptococcal antibody titer cutoffs affect diagnosis of rheumatic fever.Implications of all the available evidenceRheumatic fever remains a challenging diagnosis based on a clinical decision rule with imperfect sensitivity and specificity. Improved understanding of streptococcal antibody titers in rheumatic heart disease endemic populations may improve diagnostic performance. Our study also points to the need for development of a rheumatic fever diagnostic test, in order to provide a more definitive assessment of risk.

Strategies for heart disease in sub-Saharan Africa

Heart ◽  
2009 ◽  
Vol 95 (19) ◽  
pp. 1559-1560 ◽  
Author(s):  
A J Brink ◽  
J Aalbers
Keyword(s):  
Heart Disease ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Risk factors and prevalence of dilated cardiomyopathy in Sub Sahara Africa: a systematic review article (Preprint)

2020 ◽  
Author(s):  
Linda Van Laake ◽  
Lulu Said Fundikira ◽  
Pilly Chillo ◽  
David G Paulo ◽  
Reuben Kato Mutagaywa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Dilated Cardiomyopathy ◽  
Preventive Measures ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Sub Saharan Africa ◽  
Inclusion Criteria ◽  
Reference Manager ◽  
Sub Saharan

BACKGROUND Cardiomyopathies, defined as diseases involving mainly the heart muscle, are linked to 5.9 of 100,000 of estimated mortality of the global population although underdiagnosis is significant. In sub Saharan Africa, studies show that cardiomyopathy constitutes 21.4% of cases with heart failure and comes second only to hypertensive heart disease. However, there is paucity of data in the region regarding the different types of cardiomyopathies. It has been noted that presence of non-modifiable cardiovascular risk factors such as family history, age, ethnicity, gender as well as modifiable risk factors such as hypertension, diabetes, tobacco use, physical inactivity, poor nutrition, excessive alcohol consumption, high cholesterol and obesity increase the probability of developing cardiovascular disease. OBJECTIVE The review will focus on available literature in sub- Saharan Africa on prevalence of dilated cardiomyopathy (DCM) and associated risk factors in patients with DCM. It will identify gaps in knowledge regarding DCM and establish a foundation for preventive measures through reduction of the risk factors. This will be the first review that focuses solely on DCM while updating available data from previous reviews on cardiomyopathies in sub Saharan Africa. METHODS The review will consider all studies, qualitative and quantitative, which involve patients with a diagnosis of dilated cardiomyopathy as well as risk factors encountered in such patients in sub Saharan Africa. Both hospital based and community based studies will be included. Indexed articles in Medline and Embase will be searched. Full copies of articles identified by the search, and considered to meet the inclusion criteria, based on their title, abstract and subject descriptors, will be obtained for data synthesis. Bibliographic searches will also be considered for data collection based on their titles. The collected data will be organized in Mendeley reference manager and later on uploaded to Rayyan web application for systematic reviews articles to allow adequate sorting. Two reviewers will independently select articles against the inclusion criteria. Discrepancies in reviewer selections will be resolved by a third author (arbitrator) prior to selected articles being retrieved. RESULTS Interventions to be documented will include those related to screening and control of risk factors that may lead to DCM, and presence of assessment strategies in patients suspected with DCM. The primary outcome will be the number of cases with different etiologies of DCM. Secondary outcomes will be the number of hospitalizations, mortality due to heart failure, incidence of sudden cardiac death, proportion of participants on heart failure medications, proportion of participants with implantable cardioverter defibrillator placements, number of cases with left ventricular assist device and number of heart transplants in patients with DCM. CONCLUSIONS The review will give an update on the status of DCM in sub Sahara Africa and identify gaps that need to be addressed in order to improve preventive measures as well as management of this condition.

scholarly journals Exome Sequencing and Congenital Heart Disease in Sub-Saharan Africa

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ekanem N. Ekure ◽  
Adebowale Adeyemo ◽  
Hanhan Liu ◽  
Ogochukwu Sokunbi ◽  
Nnenna Kalu ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Exome Sequencing ◽  
Congenital Heart ◽  
De Novo ◽  
Sub Saharan Africa ◽  
Disease Genes ◽  
Loss Of Function ◽  
Unique Identifier ◽  
Sub Saharan

Background: Congenital heart disease (CHD) is the most common birth defect and affects roughly 1% of the global population. There have been many large CHD sequencing projects in developing countries but none in sub-Saharan Africa. In this exome sequencing study, we recruited families from Lagos, Nigeria, affected by structural heart disease. Methods: Ninety-eight participants with CHD and an average age of 3.6 years were recruited from Lagos, Nigeria. Exome sequencing was performed on probands and parents when available. For genes of high interest, we conducted functional studies in Drosophila using a cardiac-specific RNA interference–based gene silencing system. Results: The 3 most common CHDs were tetralogy of Fallot (20%), isolated ventricular septal defect (14%), and transposition of the great arteries (8%). Ten percent of the cohort had pathogenic or likely pathogenic variants in genes known to cause CHD. In 64 complete trios, we found 34 de novo variants that were not present in the African population in the Genome Aggregation Database (v3). Nineteen loss of function variants were identified using the genome-wide distribution of selection effects for heterozygous protein-truncating variants (s het ). Nine genes caused a significant mortality when silenced in the Drosophila heart, including 4 novel disease genes not previously associated with CHD ( UBB, EIF4G3, SREBF1 , and METTL23 ). Conclusions: This study identifies novel candidate genes and variants for CHD and facilitates comparisons with previous CHD sequencing studies in predominantly European cohorts. The study represents an important first step in genomic studies of CHD in understudied populations. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01952171.

scholarly journals Acquired heart disease in low-income and middle-income countries

2017 ◽  
Vol 103 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Chris Curry ◽  
Liesl Zuhlke ◽  
Ana Mocumbi ◽  
Neil Kennedy
Keyword(s):  
Heart Disease ◽  
Low Income ◽  
Burden Of Illness ◽  
Sub Saharan Africa ◽  
Endomyocardial Fibrosis ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Middle Income Countries ◽  
Acquired Heart Disease ◽  
Sub Saharan

The burden of illness associated with acquired cardiac disease in children in low-income and middle-income countries (LMIC) is significant and may be equivalent to that of congenital heart disease. Rheumatic heart disease, endomyocardial fibrosis, cardiomyopathy (including HIV cardiomyopathy) and tuberculosis are the most important causes. All are associated with poverty with the neediest children having the least access to care. The associated mortality and morbidity is high. There is an urgent need to improve cardiac care in LMIC, particularly in sub-Saharan Africa and parts of Southeast Asia where the burden is highest.

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