The 15th biennial Pan-African Society of Cardiology (PASCAR) congress held in Mombasa, Kenya, in November 2021, convened in its legacy of being the largest Pan-African conference on cardiovascular diseases (CVDs). The congress brough together members of cardiovascular societies from across the continent in the shared mission of advancing cardiovascular health in Africa. In partnership with the Kenyan Cardiac Society (KCS), the specific aims of the PASCAR conference were to (1) advance knowledge on CVDs in the region; (2) share local data, clinical cases, challenges and solutions and reinforce collaborative capacity initiatives in research and workforce training; (3) engage with policy makers to address health-system issues affecting access to CVD care in Africa; and (4) bring together local and international thought leaders in cardiovascular medicine to strengthen the partnerships between PASCAR, KCS, other African cardiac societies and key global stakeholders. Due to the COVID-19 pandemic, this congress demonstrated great success in providing both an in-person and a virtual platform of attendance, therefore making this an inaugural hybrid PASCAR congress, with inclusive and widespread participation from across the globe. We highlight the key areas of focus, various educational programmes and innovative initiatives that shaped the 15th PASCAR congress, including expert consensus on the future directions for advancing CVD care in Africa.
We sought to address the paucity of data to support the evidence-based management of hypertension to achieve optimal blood pressure (BP) control on a sex-specific basis in Africa.We undertook a post hoc analysis of the multicenter, randomized CREOLE (Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans) Trial to test the hypothesis that there would be clinically important differences in office BP control between African men and women. We compared the BP levels of 397 and 238 hypertensive women (63%, 50.9 ± 10.5 years) and men (51.2 ± 11.3 years) from 10 sites across sub-Saharan Africa who completed baseline and 6-month profiling according to their randomly allocated antihypertensive treatment.Overall, 442/635 (69.6%) participants achieved an office BP target of <140/90 mm Hg at 6 months; comprising more women (286/72.0%) than men (156/65.5%) (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.07-2.39; P = 0.023). Women randomized to amlodipine-hydrochlorothiazide (HCTZ) (adjusted OR 3.03, 95% CI 1.71-5.35; P < 0.001) or amlodipine-perindopril (adjusted OR 2.62, 95% CI 1.49-4.58; P = 0.01) were more likely to achieve this target compared with perindopril-HCTZ. Among men, there were no equivalent treatment differences-amlodipine-HCTZ (OR 1.54, 95% CI 0.76-3.12; P = 0.23) or amlodipine-perindopril (OR 1.32, 95% CI 0.65-2.67; P = 0.44) vs. perindopril-HCTZ. Among the 613 participants (97%) with 24-hour ambulatory BP monitoring, women had significantly lower systolic (124.1 ± 18.1 vs. 127.3 ± 16.9; P = 0.028) and diastolic (72.7 ± 10.4 vs. 75.1 ± 10.5; P = 0.007) BP levels at 6 months compared with men.These data suggest clinically important differences in the therapeutic response to antihypertensive combination therapy among African women compared with African men.
To reduce excess dietary sodium consumption, Nigeria's 2019 National Multi-sectoral Action Plan (NMSAP) for the Prevention and Control of Non-communicable Diseases includes policies based on the World Health Organization SHAKE package. Priority actions and strategies include mandatory sodium limits in processed foods, advertising restrictions, mass-media campaigns, school-based interventions, and improved front-of-package labeling. We conducted a formative qualitative evaluation of stakeholders' knowledge, and potential barriers as well as effective strategies to implement these NMSAP priority actions.
Research Objective The prevalence of hypertension among adults in Nigeria is high (29‐45%), yet awareness (14‐30%), treatment (<20%), and control (9%) rates are low. The Hypertension Treatment in Nigeria study aims to improve awareness, treatment, and control of hypertension in Nigeria through adaptation, implementation, and evaluation of a system‐level hypertension control program based on the World Health Organization’s (WHO) HEARTs package. Study Design We performed facility‐based capacity and readiness assessments to inform our implementation and adaptation strategies and research plan at public primary health centers (PHCs) by adapting the WHO’s Service Availability and Readiness Assessment (SARA). SARA assessments were performed by interviewing the highest‐level site staff, pharmacists, and laboratory technicians at each PHC. Capacity and readiness assessments were based on staffing levels, availability of key steps in hypertension treatment cascade, equipment and supplies, information system infrastructure, and availability of blood pressure (BP)‐lowering medicines. Population Studied Among 243 public PHCs within 6 council areas and 62 wards in the Federal Capital Territory of Nigeria, we selected 60 PHCs through a multistage sampling frame. SARA assessments were completed by the research team between May 2019 and October 2019 at all (n = 60; 100%) PHCs. Principal Findings Most PHCs (n = 54; 90%) had sufficient human resource capacity based on self‐report of two or more full‐time staff. The median (interquartile range [IQR]) number of full‐time staff was 5 (3‐8), predominantly comprised of community health extension workers (median 3; IQR 2‐5) and nurses (median 1; IQR 0‐2). Few (n = 8; 15%) sites received any training for diagnosis and management of cardiovascular diseases within the previous two years. All (n = 60; 100%) sites had sufficient capacity for screening and most for diagnosis (n = 56; 93%) and confirmation (n = 53; 88%) of hypertension. Nearly two‐thirds had capacity for dispensing initial (n = 35; 58%) or follow‐up (n = 37; 62%) BP‐lowering medication and for providing long‐term continued care (n = 38; 63%) for patients with hypertension. Few PHCs had guidelines (n = 7; 13%), treatment algorithms (n = 3; 5%), or information materials (n = 1; 2%) for hypertension diagnosis or management. Most sites (n = 55; 92%) had at least one functional BP apparatus. All sites relied on paper based records, and relatively few had a functional computer (n = 10; 17%) or access to Internet or email (n = 5; 8%). Calcium channel blockers (n = 19 PHCs; 32%) were the most prevalently stocked BP‐lowering medication, followed by central acting agents (n = 11; 19%) and angiotensin‐converting enzyme inhibitors (n = 10; 17%). Despite inclusion on the WHO and Nigeria essential medicines lists, the median (IQR) number of 30‐day treatment regimens of all BP‐lowering medications in stock on the day of assessment was 0 (0‐20) and 35 (59%). PHCs had no BP‐lowering medication in stock. Conclusions We demonstrated feasibility of implementation based on workforce, equipment, and information systems. Implications for Policy or Practice This study was the first systematic assessment of capacity and readiness for a system‐level hypertension control program within the Federal Capital Territory of Nigeria. The results demonstrate a critical need for essential medicine supply strengthening, health worker training, and protocols for hypertension treatment and control rates in Nigeria. Primary Funding Source National Institutes of Health.
Abstract Background : Nigeria faces an increase in the burden of non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), leading to an estimated 29% of all deaths in the country. Nigeria has an estimated hypertension prevalence ranging from 25% to 40% of her adult population. Despite this high burden, awareness (14-30%), treatment (<20%), and control (9%) rates of hypertension are low in Nigeria. Against this backdrop, we sought to perform capacity and readiness assessments of public Primary Healthcare Centers (PHCs) to inform Nigeria's system-level hypertension control program's implementation and adaptation strategies. Methods : The study employed a multi-stage sampling to select 60 from the 243 PHCs in the Federal Capital Territory (FCT) of Nigeria. The World Health Organization (WHO) Service Availability and Readiness Assessment was adapted to focus on hypertension diagnosis and treatment and was administered to PHC staff from May 2019 – October 2019. Indicator scores for general and cardiovascular service readiness were calculated based on the proportion of sites with available amenities, equipment, diagnostic tests, and medications. Results : Median (interquartile range [IQR]) number of full-time staff was 5 (3-8), and were predominantly community health extension workers (median = 3 [IQR 2-5]). Few sites (n=8; 15%) received cardiovascular disease diagnosis and management training within the previous two years, though most had sufficient capacity for screening (n=58; 97%), diagnosis (n=56; 93%), and confirmation (n=50; 83%) of hypertension. Few PHCs had guidelines (n=7; 13%), treatment algorithms (n=3; 5%), or information materials (n=1; 2%) for hypertension. Most sites (n=55; 92%) had one or more functional blood pressure apparatus. All sites relied on paper records, and few had a functional computer (n=10; 17%) or access to internet (n=5; 8%). Despite inclusion on Nigeria’s essential medicines list, 35 (59%) PHCs had zero 30-day treatment regimens of any blood pressure-lowering medications in stock. Conclusions : This first systematic assessment of capacity and readiness for a system-level hypertension control program within the FCT of Nigeria demonstrated implementation feasibility based on the workforce, equipment, and paper-based information systems, but a critical need for essential medicine supply strengthening, health-worker training, and protocols for hypertension treatment and control in Nigeria.
Contrary to elderly patients with ischaemic-related acute heart failure (AHF) typically enrolled in North American and European registries, patients enrolled in the sub-Saharan Africa Survey of Heart Failure (THESUS-HF) were middle-aged with AHF due primarily to non-ischaemic causes. We sought to describe factors prognostic of re-admission and death in this developing population. Prognostic models were developed from data collected on 1006 patients enrolled in THESUS-HF, a prospective registry of AHF patients in 12 hospitals in nine sub-Saharan African countries, mostly in Nigeria, Uganda, and South Africa. The main predictors of 60-day re-admission or death in a model excluding the geographic region were a history of malignancy and severe lung disease, admission systolic blood pressure, heart rate and signs of congestion (rales), kidney function (BUN), and echocardiographic ejection fraction. In a model including region, the Southern region had a higher risk. Age and admission sodium levels were not prognostic. Predictors of 180-day mortality included malignancy, severe lung disease, smoking history, systolic blood pressure, heart rate, and symptoms and signs of congestion (orthopnoea, peripheral oedema and rales) at admission, kidney dysfunction (BUN), anaemia, and HIV positivity. Discrimination was low for all models, similar to models for European and North American patients, suggesting that the main factors contributing to adverse outcomes are still unknown. Despite the differences in age and disease characteristics, the main predictors for 6 months mortality and combined 60 days re-admission and death are largely similar in sub-Saharan Africa as in the rest of the world, with some exceptions such as the association of the HIV status with mortality.
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