46 research outputs found
Left ventricular geometry and function in Tanzanian patients with hypertension and diabetes
No full textFrom echocardiographic studies in hypertension, African Americans have been found to be more prone to develop cardiac target-organ damage than Caucasians. Hypertension is among the major upcoming health problems in Africa. However, there is a lack of knowledge about cardiac structural and functional changes in hypertension and diabetes in native sub-Saharan Africans. This thesis consists of 3 studies that aimed at determining the prevalence, covariates and functional consequences of abnormal left ventricular (LV) geometry in native Tanzanian patients with hypertension and diabetes attending out-patient clinics at Muhimbili National Hospital in Dar es Salaam, Tanzania. In study I, 161 untreated hypertensive patients, and 80 age- and sex-matched normotensive controls were studied. Studies II and III included 123 type 2 and 61 type 1 diabetic patients with about 10 years duration of diabetes. The prevalence of abnormal LV geometry was 77% in type 2 diabetic patients, 62.1% in untreated hypertensives, 40% in type 1 diabetic patients and 12.5% among the controls. Concentric LV hypertrophy was the most common abnormal LV geometric pattern in type 2 diabetes (in 47% of patients with abnormal LV geometry) and in untreated hypertensive patients (in 42% of patients with abnormal LV geometry), while concentric remodelling was the predominant type of abnormal LV geometry in type 1 diabetic patients (in 75% of patients with abnormal LV geometry) and in controls (90% of controls with abnormal LV geometry). Higher systolic blood pressure, obesity and impaired renal function were the main independent determinants of abnormal LV geometry both in patients with hypertension and in diabetes. Abnormal LV geometry was associated with subclinical LV myocardial systolic dysfunction both in hypertension and in diabetes, as well as subclinical LV diastolic dysfunction independent of clinical covariates. A risk score comprising key clinical variables in standard assessment of diabetic patients (type of diabetes, hypertension, obesity and abnormal albuminuria) was developed. This score demonstrated that presence of either hypertension, obesity or abnormal albuminuria in a patient with type 2 diabetes or presence of any 2 of these clinical variables in a type 1 diabetic patient identified 3 out of 4 diabetic patients with echocardiographic abnormal LV geometry (concentric remodelling or concentric LV hypertrophy, the main types of abnormal LV geometry in the diabetic patients). The ability of enlarged left atrial volume index (LAVI) to detect subclinical LV diastolic dysfunction in diabetic patients was tested, and was found to be a good indicator of LV diastolic dysfunction in type 2 diabetic patients while LAVI reflected early diabetic cardiomyopathy in type 1 diabetic patients. In conclusion, abnormal LV geometry is very prevalent in asymptomatic Tanzanian patients with hypertension and/or diabetes, increased by 4-6 folds compared to healthy controls, and is associated with subclinical LV systolic and diastolic dysfunction
Cardiovascular Risk Factors among Primary School Children Aged 6 - 15 years in Urban Dar es Salaam and Rural Morogoro: Prevalence, Awareness and Knowledge.
No full textonce known as diseases of the Western world have recently been emerged as diseases of public health importance in many developing countries. Change in life style and socio- economic status associated with urbanization is thought to be the major contributing factor for this trend. In its message to the developing countries, the World Health Organization has urged for a prompt control of cardiovascular diseases at an early stage before the burden becomes more severe. The need for Primordial Prevention has highly been recommended. To determine the prevalence, awareness and knowledge of the conventional cardiovascular risk factors among primary school children aged 6 - 15 years in Urban Dar es Salaam and Rural Morogoro. Cross sectional survey of children aged 6 - 15 years from four primary schools in Urban Dar es Salaam and two primary schools in Rural Morogoro. Anthropometric and Blood Pressure measurements were done using the standard techniques, blood samples taken and analysed for sugar, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides levels. A standard questionnaire was used to obtain socio- IX demographic characteristics and to assess the level of awareness and knowledge of the main cardiovascular diseases among the children. The prevalence of systolic, diastolic and both (systolic and diastolic) hypertension was found to be 11.4%, 8.1% and 3.9% respectively among the 508 children studied. Twenty one (4.1%) subjects had high total cholesterol levels, while high LDL-C levels were found in 10 subjects (2%). The prevalence of obesity was found to be 5.3%. Only six (1.2%) subjects were having active cigarette smoking. Passive smoking was found in 35% of the total study population. Majority of the study population were generally active. None of the subjects had blood ., sugar levels that were equivalent to diabetic levels. Subjects from the Urban Low Density schools were more likely to be hypertensive, obese and with high levels of total cholesterol and LDL-C, furthermore they were more likely to have less physical activities as compared to those from the Urban High Density and Rural schools. In addition, subjects from ULD schools were more likely to be aware and to have more knowledge of cardiovascular diseases as compared to those from the UHD and Rural schools. Cardiovascular risk factors are generally low among children in this society although certain groups of children have x increased risk. There is low level of awareness and knowledge of cardiovascular diseases and their precursors among children
Prevalence and predictors of left ventricular dysfunction among patients with chronic kidney disease attending Muhimbili National Hospital in Tanzania — a cross-sectional study
No full textPilly Chillo, Eva Mujuni Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Purpose: Chronic kidney disease (CKD) is prevalent in sub-Saharan Africa and is a significant cause of mortality, which may result from kidney failure or congestive heart failure – a frequent complication of CKD. There is however scarcity of documented literature on the magnitude and associated factors of echocardiographically determined left ventricular (LV) dysfunction among CKD patients in Tanzania. Patients and methods: A prospective cross-sectional study was conducted from May 2014 to January 2015 at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Patients ≥18 years with CKD were consecutively enrolled. Clinical characteristics, cardiovascular risk profiles, and laboratory findings including serum creatinine, urea, hemoglobin, and cholesterol levels were collected. Echocardiography was performed to assess LV function using standard criteria. Results: One hundred and ninety-one CKD patients fulfilled the inclusion criteria. The mean ± SD age was 48 ± 13 years, and 54.5% were men. A total of 98.4% of the patients were hypertensive, and diabetes was present in 22.8% while 97.9% had end-stage renal disease. The prevalence of LV systolic and diastolic dysfunction was 16.2% and 68.6%, respectively. A ­clinical finding of heart failure was the only independent predictor of LV systolic dysfunction (odds ratio [OR] = 2.9, p = 0.012), while independent predictors of LV diastolic dysfunction were anemia (OR = 4.9, p = 0.01), severe hypertension (OR = 9.2, p = 0.001), and female gender (OR = 1.7, p = 0.002). Conclusion: LV dysfunction is prevalent among CKD patients seen at MNH and is associated with clinical heart failure, anemia, severe hypertension, and female gender. Echocardiography should be performed in patients with CKD to detect overt or subclinical LV dysfunction. Keywords: chronic kidney disease, left ventricular dysfunction, sub-Saharan Afric
Association between body fat composition and blood pressure level among secondary school adolescents in Dar es Salaam, Tanzania
No full textIntroduction: excess body fat and high blood pressure (BP) are important risk factors for increased cardiovascular morbidity and mortality, and both may have their roots of occurrence in childhood and adolescence. The present study aimed at determining the association between body fat composition and BP level among adolescents in Tanzania.
Methods: a cross-sectional study involving 5 randomly selected secondary schools within Dar es Salaam was conducted between June and November 2013. Structured questionnaires were used to collect information on demographic characteristics and other cardiovascular risk factors. BP, height, weight and waist circumference were measured following standard methods. Body fat was assessed by skinfold thickness and categorized as underfat, healthy, overfat or obese according to World Health Organization definitions. Hypertension was defined as BP ≥ 90th percentile for age, height and gender of the adolescent.
Results: the study included 582 adolescents (mean age 16.5±1.8 years, 52.1% boys). The proportion of adolescents with overfat or obesity was 22.2%. Systolic, diastolic and combined hypertension was present in 17.5%, 5.5%, and 4.0% respectively. In the total population mean body fat percent correlated positively with diastolic BP and mean arterial pressure (MAP) but not with systolic BP. In multivariate analysis body mass index (β=0.21, p=0.008) and waist circumference (β=0.12, p=0.049), but not body fat percentage (β=-0.09, p=0.399) independently predicted higher MAP.
Conclusion: body mass index predicts BP level better than body fat composition and should be used as a measure of increased risk for hypertension among adolescents
Prevalence and predictors of left ventricular dysfunction among patients with chronic kidney disease attending Muhimbili National Hospital in Tanzania — a cross-sectional study
No full textApplicability of structured telephone monitoring to follow up heart failure patients discharged from Muhimbili National Hospital, Tanzania
No full textBackground: Studies from developed countries have shown that home monitoring and follow up of heart failure (HF) patients by use of phone calls is cost-effective as it reduces re-admission and improves patients’ clinical status. This intervention has however not been tested in resource poor countries including Tanzania, and there are questions as to whether it is applicable in such situations. This study was carried out to determine the applicability of structured telephone monitoring of HF patients discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: All heart failure patients admitted at the hospital’s Cardiovascular Medicine Department between August and December 2014 were consecutively recruited. Information on their clinical and demographic characteristics was collected and their mobile phone numbers recorded. Patients were then contacted through their phones on day 7, 14 and 30 post discharge and inquiry on their clinical status was made.Results: A total of 164 HF patients were admitted during the study period, of these 4 declined to participate, 3 could not establish a phone number and 26 died before discharge leaving 131 (79.9%) for follow-up. The mean age was 45±19 years and 56.5% were women. The proportion of patients that could be contacted through mobile phones were 96.2%, 94.7% and 93.9% on day 7, 14 and 30 post discharge, respectively. Over 90% of the contacted patients gave valuable information regarding their clinical status.Conclusion: Majority of HF patients can be contacted and provide valuable clinical information through mobile phones within a month post discharge from the national hospital in Tanzania. Structured telephone monitoring could be used as a tool to follow up HF patients in a resource-poor country like Tanzania
Impact of Non-Ischemic Dilated Cardiomyopathy in Tanzania
No full textIn the general introduction in Chapter 1, we noted dual existence of communicable diseases with emergent non-communicable diseases in Tanzania which are alarmingly on the rise. We also observed the high prevalence of cardiovascular risk factors (CRF) such as hypertension and obesity in the community. Additionally, we observed that NIDCM is a common cause of heart failure (HF) and found in all age groups and across all regions of SSA. Literature reveals distinctive presentation in SSA due to socio-demographics, environmental and potentially genetic factors compared to what is reported in high income countries. In Chapter 2, the systematic review of NIDCM in SSA explored the magnitude of the condition in the region and assess associated risk factors. There were wide variations in prevalence of NIDCM in the region which was compounded with the non-uniform definition of NIDCM. Notwithstanding, we established that NIDCM is a common condition in patients with HF in SSA. We failed to identify any studies that focused on the interaction of NIDCM and established CRF. This observation called for a further look into CRF and NIDCM which formed the rationale for installing the MOYO (characterization of non-ischeMic dilated cardiomyOpathY in a native Tanzanian cOhort) cohort. With the MOYO cohort in Chapter 3, we observed in our cohort a slight male predominance, with majority of patients presenting clinically advanced New York Heart Association (NYHA) class and severe systolic dysfunction. While most cases were due to idiopathic or presumed hypertensive cardiomyopathy, at least one in every ten patients had PPCM. Despite the advanced disease in the majority of patients, the use of ESC guidelines recommended medications was suboptimal. Family screening of 57 first degree relatives of patients with idiopathic NIDCM is presented in Chapter 4. Despite challenges due to low turn up of the family for screening as well as the lack of access to other diagnostic modalities used in family screening; we identified 14.1% of screened family members to have previously unknown NIDCM. They were predominantly young, most often female and all of them asymptomatic. In Chapter 5, the outcome after a mean follow up of 19±7months, 60% of the cohort of 402 patients were alive, one fifth had died and nearly another fifth was lost to follow up (LTFU). Use of device implant was extremely low. Severe systolic dysfunction on echocardiography recorded at baseline was an independent predictor of mortality outcome. In Chapter 6, we conclude that NIDCM is among the leading cardiovascular cause of morbidity and mortality in the most productive age of the population in Tanzania, and yet there is inadequate control of CRF and limited access to care. Furthermore, the underlying etiologies and socio-demographics characteristics from what has been described in HIC, calling for tailored diagnostic and management protocol suitable for the Tanzanian and possibly SSA population. We recommend comprehensive screening programs, the establishment of tailored management protocols, and an exploration into the genetic underpinnings NIDCM in Tanzania
Factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania
No full textCardiovascular diseases, including heart failure are a known
complication of Human Immunodeficiency Virus (HIV) infection globally.
The objective of this study was to describe factors associated with,
and echocardiographic findings of heart failure among HIV infected
patients at a tertiary health care facility in Dar es Salaam, Tanzania.
Clinical, laboratory and echocardiographic assessment was performed in
all HIV-infected patients presenting with cardiac complaints at the
medical department, Muhimbili National Hospital between September 2009
and April 2010. HF was diagnosed clinically and confirmed by
echocardiography. Of the 102 HIV-infected patients with cardiac
complaints 50 (49%) were in HF. Commonest causes of HF were
hypertensive heart disease, pulmonary hypertension and dilated
cardiomyopathy. In multivariate analysis male gender (OR 4.03), low
education (OR 4.91), previous history of tuberculosis (OR 3.01), and
low haemoglobin (OR 0.83), were independently associated with the
diagnosis of HF (p<0.05 for all). In conclusion, heart failure is
common in HIV-infected patients with cardiac complaints, and is
associated with both modifiable and non-modifiable factors
Hypertensive retinopathy and associated factors among nondiabetic chronic kidney disease patients seen at a tertiary hospital in Tanzania: a cross-sectional study
No full textPilly Chillo,1 Ame Ismail,1 Anna Sanyiwa,2 Paschal Ruggajo,1 Appolinary Kamuhabwa31Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 3Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaBackground: Hypertensive retinopathy is a known marker of cardiovascular disease, and among unselected patients with chronic kidney disease (CKD) more severe retinopathy has been associated with lower estimated glomerular filtration rate (eGFR). This association has, however, not been widely studied among nondiabetic hypertensive patients with CKD, especially in sub-Saharan Africa. We aimed to determine the prevalence and severity of hypertensive retinopathy and its relationship with eGFR among nondiabetic CKD patients seen at Muhimbili National Hospital in Dar es Salaam, Tanzania.Methods: A hospital-based cross-sectional study was conducted among nondiabetic CKD adult (≥18 years) patients with hypertension. A structured questionnaire was used to record patients’ demographic characteristics and their cardiovascular risk profile. eGFR was calculated using the Modification of Diet in the Renal Disease (MDRD) equation and only patients with CKD stage 3 or more were enrolled in the study. Grading of retinopathy was done using the Keith–Wagener classification.Results: In total, 224 patients fulfilled the inclusion criteria and were enrolled. Their mean age was 45.8±14.1 years, and 59.4% were men. The proportions of patients with stage 3, 4, and 5 CKD were 21.4%, 19.6%, and 58.9%, respectively. Hypertensive retinopathy was present in 157 (70.1%) patients and the proportions with grade I, grade II, grade III, and grade IV retinopathy were 17.9%, 18.8%, 19.6%, and 13.8%, respectively. The severity of retinopathy increased with decreasing levels of eGFR, and in multivariate logistic regression analysis, factors found to be independently associated with ≥grade II hypertensive retinopathy were more severe CKD, higher hypertension grades, and alcohol use, all p<0.05.Conclusion: The prevalence of hypertensive retinopathy is high among nondiabetic CKD patients seen at a tertiary hospital in Tanzania and is independently associated with CKD severity. Retinopathy grade can be used as a marker of CKD severity among these patients.Keywords: sub-Saharan Africa, cardiovascular disease, renovascular disease, cardiovascular marker
Factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania.
No full textAbstract: Cardiovascular diseases, including heart failure are a known complication of Human
Immunodeficiency Virus (HIV) infection globally. The objective of this study was to describe factors
associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary
health care facility in Dar es Salaam, Tanzania. Clinical, laboratory and echocardiographic assessment was
performed in all HIV-infected patients presenting with cardiac complaints at the medical department,
Muhimbili National Hospital between September 2009 and April 2010. HF was diagnosed clinically and
confirmed by echocardiography. Of the 102 HIV-infected patients with cardiac complaints 50 (49%) were in HF.
Commonest causes of HF were hypertensive heart disease, pulmonary hypertension and dilated
cardiomyopathy. In multivariate analysis male gender (OR 4.03), low education (OR 4.91), previous history of
tuberculosis (OR 3.01), and low haemoglobin (OR 0.83), were independently associated with the diagnosis of
HF (p<0.05 for all). In conclusion, heart failure is common in HIV-infected patients with cardiac complaints, and
is associated with both modifiable and non-modifiable factors
