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1. Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review.

Author

Okpechi IG, Chukwuonye II, Ekrikpo U, Noubiap JJ, Raji YR, Adeshina Y, Ajayi S, Barday Z, Chetty M, Davidson B, Effa E, Fagbemi S, George C, Kengne AP, Jones ESW, Liman H, Makusidi M, Muhammad H, Mbah I, Ndlovu K, Ngaruiya G, Okwuonu C, Samuel-Okpechi U, Tannor EK, Ulasi I, Umar Z, Wearne N, and Bello AK

Subjects
Humans, Counseling, Kidney, Malawi, Noncommunicable Diseases, Hypertension epidemiology, Hypertension therapy
Abstract

Background: Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations., Methods: We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively., Results: Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively., Conclusion: Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined., (© 2023. The Author(s).)

Published
2023
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2. Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross-sectional study.

Author

Tannor EK, Sarfo FS, Mobula LM, Sarfo-Kantanka O, Adu-Gyamfi R, and Plange-Rhule J

Subjects
Adult, Aged, Blood Pressure physiology, Cardiovascular Diseases epidemiology, Clinical Decision Rules, Creatinine blood, Cross-Sectional Studies, Female, Ghana epidemiology, Global Burden of Disease statistics & numerical data, Humans, Hypertension complications, Male, Middle Aged, Prevalence, Prospective Studies, Proteinuria diagnosis, Proteinuria etiology, Renal Insufficiency, Chronic etiology, Risk Factors, Surveys and Questionnaires, Cardiovascular Diseases prevention & control, Diabetes Mellitus epidemiology, Herbal Medicine statistics & numerical data, Hypertension epidemiology, Renal Insufficiency, Chronic epidemiology
Abstract

The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing age aOR 1.26 (1.17-1.36), low educational level aOR 1.7 (1.23-2.35), duration of HPT OR, 1.02 (1.01-1.04), and use of herbal medications aOR 1.39 (1.10-1.75). Female gender was protective of CKD aOR 0.75 (0.62-0.92). Among patients with DM, increasing age and systolic blood pressure were associated with CKD. There is high prevalence of CKD among DM and hypertension patients in Ghana. Optimizing blood pressure control and limiting the use of herbal preparations may mitigate CKD occurrence in high cardiovascular risk populations in developing countries., (©2019 Wiley Periodicals, Inc.)

Published
2019
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3. May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Author

Beaney, Thomas, Burrell, Louise M, Castillo, Rafael R, Charchar, Fadi J, Cro, Suzie, Damasceno, Albertino, Kruger, Ruan, Nilsson, Peter M, Prabhakaran, Dorairaj, Ramirez, Agustin J, Schlaich, Markus P, Schutte, Aletta E, Tomaszewski, Maciej, Touyz, Rhian, Wang, Ji-Guang, Weber, Michael A, Poulter, Neil R, Burazeri, Genc, Qirjako, Gentiana, Roshi, Enver, Cunashi, Rudina, Fernandes, Mario J C C, Victória Pereira, Savarino S, Neto, Marisa F M P, Oliveira, Pombalino N M, Feijão, Ana C G, Cerniello, Yamila, Marin, Marcos J, Garcia Vasquez, Fortunato, Espeche, Walter G, Stisman, Diego, Fuentes, Inés A, Zilberman, Juith M, Rodriguez, Pablo, Babinyan, Kamsar Yu, Engibaryan, Anna H, Avagyan, Avag M, Minasyan, Arsen A, Gevorkyan, Ani T, Carnagarin, Revathy, Carrington, Melinda J, Sharman, James E, Lee, Rebecca, Perl, Sabine, Niederl, Ella, Malik, Fazila-Tun-Nesa, Choudhury, Sohel R, Al Mamun, Mohammad A, Ishraquzzaman, Mir, Anthony, Fiona, Connell, Kenneth, De Backer, Tine L M, Krzesinski, Jea, Houenassi, Martin D, Houehanou, Corine Y, Sokolovic, Sekib, Bahtijarevic, Rankica, Tiro, Mary B, Mosepele, Mosepele, Masupe, Tiny K, Barroso, Weimar S, Gomes, Marco A M, Feitosa, Audes D M, Brandão, Andrea A, Miranda, Roberto D, Azevedo, Vanda M A A, Dias, Luis M, Garcia, Glenda D N, Martins, Idiana P P, Dzudie, Anastase, Kingue, Samuel, Djomou, Florent A N, Njume, Epie, Khan, Nadia, Lanas, Fernando T, Garcia, Maria S, Paccot, Melanie F, Torres, Pamela I, Li, Yan, Liu, Min, Xu, Liying, Li, Li, Chen, Xin, Deng, Junping, Zhao, Wenwu, Fu, Lingjuan, Zhou, Yi, Lopez-Jaramillo, Patricio, Otero, Johanna, Camacho, Paul A, Accini, Jose L, Sanchez, Gregorio, Arcos, Edgar, M’Buyamba-Kabangu, Jean-René, Katamba, Fortunat K, Ngoyi, Georges N, Buila, Nathan M, Bayauli, Pascal M, Ellenga Mbolla, Bertrand F, Bakekolo, Paterne R, Kouala Landa, Christian M, Kimbally Kaky, Gisele S, Kramoh, Euloge K, Ngoran, Yves N K, Olsen, Michael H, Valdez Valoy, Laura, Santillan, Marcos, Angel Rafael, Gonzalez Medina, Peñaherrera, Carlos E, Villalba, Jose, Ramirez, Maria I, Arteaga, Fabricio, Delgado, Patricia, Beistline, Holly, Cappuccio, Francesco P, Keitley, James, Tay, Tricia, Goshu, Dejuma Y, Kassie, Desalew M, Gebru, Sintayehu A, Pathak, Atul, Denolle, Thierry, Tsinamdzgvrishvili, Bezhan, Trapaidze, Dali, Sturua, Lela, Abesadze, Tamar, Grdzelidze, Nino, Grabfelder, Mark, Krämer, Bernhard K, Schmeider, Roland E, Twumasi-Ankrah, Betty, Tannor, Elliot K, Lincoln, Mary D, Deku, Enoch M, Wyss Quintana, Fernando S, Kenerson, John, Jean Baptiste, Emmanuela D, Saintilmond, Wideline W, Barrientos, Ana L, Peiger, Briggitte, Lagos, Ashley R, Forgas, Marcelo A, Lee, Vivian W Y, Tomlinson, Brian W Y, Járai, Zoltán, Páll, Dénes, More, Arun, Maheshwari, Anuj, Verma, Narsingh, Sharma, Meenakshi, Mukherjee, Tapan K, Patil, Mansi, Pulikkottil Jose, Arun, Takalkar, Anant, Turana, Yuda, Widyantoro, Bambang, Danny, Siska S, Djono, Suhar, Handari, Saskia D, Tambunan, Marihot, Tiksnadi, Badai B, Hermiawaty, Eka, Tavassoli, Elham, Zolfaghari, Mahsa, Dolan, Eamon, O'Brien, Eoin, Borghi, Claudio, Ferri, Claudio, Torlasco, Camilla, Parati, Gianfranco, Nwokocha, Chukwuemeka R, Nwokocha, Magdalene I, Ogola, Elijah N, Gitura, Bernard M, Barasa, Anders L, Barasa, Felix A, Wairagu, Anne W, Nalwa, Wafula Z, Najem, Robert N, Abu Alfa, Ali K, Fageh, Hatem A, Msalam, Omar M, Derbi, Hawa A, Bettamar, Kzaki A, Zakauskiene, Urte, Vickiene, Alvita, Calmes, Jessica, Alkerwi, Ala'a, Gantenbein, Manon, Ndhlovu, Henry L L, Masiye, Jones K, Chirwa, Maureen L, Nyirenda, Nancy M, Dhlamini, Tiyezge D, Chia, Yook C, Ching, Siew M, Devaraj, Navin K, Ouane, Nouhoum, Fane, Tidiani, Kowlessur, Sudhir, Ori, Bhooshun, Heecharan, Jaysing, Alcocer, Luis, Chavez, Adolfo, Ruiz, Griselda, Espinosa, Cutberto, Gomez-Alvarez, Enrique, Neupane, Dinesh, Bhattarai, Harikrishna, Ranabhat, Kamal, Adhikari, Tara B, Koirala, Sweta, Toure, Ibrahim A, Soumana, Kabirou H, Wahab, Kolawole W, Omotoso, Ayodele B, Sani, Mahmoud U, Okubadejo, Njideka U, Nadar, Sunil K, Al-Riyami, Hassan A, Ishaq, Mohammad, Memon, Feroz, Sidique, Sualat, Choudhry, Hafeez A, Khan, Rasheed A, Ayala, Myrian, Maidana, Angel J O, Bogado, Graciela GG, Ona, Deborah I, Atilano, Alberto, Granada, Carmela, Bartolome, Regina, Manese, Loudes, Mina, Arnold, Dumlao, Maria C, Villaruel, Mariyln C, Gomez, lynn, Jóźwiak, Jacek, Małyszko, Jolanta, Banach, Maciej, Mastej, Mirosław, de Carvalho Rodrigues, Manuel M, Martins, Luis L, Paval, Alexandra, Dorobantu, Maria, Konradi, Alexandra O, Chazova, Irina E, Rotar, Oxana, Spoares, Miryan C, Viegas, Deolsanik, Almustafa, Bader A, Alshurafa, Saleh A, Brady, Adrian, Bovet, Pascal, Viswanathan, Bharathi, Oladapo, Olulola O, Russell, James W, Brguljan-Hitij, Jana, Bozic, Nina, Knez, Judita, Dolenc, Primoz, Hassan, Mohammed M, Woodiwiss, Angela J, Myburgh, Caitlynd, Vally, Muhammed, Ruilope, Luis M, Molinero, Ana, Rodilla, Enrique, Gijón-Conde, Teresa, Beheiry, Hind M, Ali, I A, Osman, Asma A A, fahal, Naiema A W, Osman, Hana A, Altahir, Fatima, Persson, Margaretha, Wuerzner, Gregoire, Burkard, Thilo, Wang, Tzung-Dau, Lin, Hung-Ju, Pan, Heng-Yu, Chen, Wen-Jone, Lin, Eric, Mondo, Charles K, Ingabire, Prossie M, Khomazyuk, Tatyana TA, Krotova, Viktoriia V-Yu, Negresku, Elena, Evstigneeva, Olena, Bazargani, Nooshin NB, Agrawal, Amrish, Bin Belaila, Buthaina A, Suhail, Aisha M, Muhammed, Khalifa O, Shuri, Hassan H, Wainford, Richard D, Levy, Philip D, Boggia, José JG, Garré, Laura L, Hernandez-Hernandez, Rafael, Octavio-Seijas, Jose A, Lopez-Rivera, Jesus A, Morr, Igor, Duin, Amanda, Huynh, Minh V, Cao, Sinh T, Nguyen, Viet L, To, Muoi, Phan, Hung N, Cockroft, John, McDonnell, Barry, Goma, Fastone M, Syatalimi, Charity, Chifamba, Jephat, Gwini, Rudo, Tiburcio, Osiris Valdez, Xia, Xin, 20035632 - Kruger, Ruan, 10922180 - Schutte, Aletta Elisabeth, Beaney T., Burrell L.M., Castillo R.R., Charchar F.J., Cro S., Damasceno A., Kruger R., Nilsson P.M., Prabhakaran D., Ramirez A.J., Schlaich M.P., Schutte A.E., Tomaszewski M., Touyz R., Wang J.-G., Weber M.A., Poulter N.R., and Borghi C

Subjects
Male, Cardiac & Cardiovascular Systems, Cross-sectional study, Blood Pressure, 030204 cardiovascular system & hematology, Global Burden of Disease, 0302 clinical medicine, Surveys and Questionnaires, MMM Investigators, Mass Screening, 030212 general & internal medicine, 1102 Cardiorespiratory Medicine and Haematology, Antihypertensive medication, RISK, Global, Awareness, Middle Aged, PREVALENCE, Hypertension, Blood pressure, Screening, Raised blood pressure, Female, Cardiology and Cardiovascular Medicine, BURDEN, Life Sciences & Biomedicine, Control, Adult, medicine.medical_specialty, Fast Track Clinical Research, Opportunistic Sampling, 03 medical and health sciences, Internal medicine, medicine, SYSTEMATIC ANALYSIS, MANAGEMENT, Humans, Mass screening, Disease burden, Antihypertensive Agents, Science & Technology, business.industry, Case-control study, Blood Pressure Determination, Treatment, Editor's Choice, RAMADAN, Cross-Sectional Studies, Cardiovascular System & Hematology, Case-Control Studies, Cardiovascular System & Cardiology, business, Hypertension, Blood pressure, Screening, Global, Treatment, Control
Abstract

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk.

Published
2019

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