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Cardiovascular risk factor burden in Africa and the Middle East across country income categories: a post hoc analysis of the cross-sectional Africa Middle East Cardiovascular Epidemiological (ACE) study.

ABSTRACT: Background:A significant number of cardiovascular disease (CVD)-related deaths occur in developing countries. An increasing prevalence of CVD is associated with a change in the macro-economy of these countries. In this post hoc analysis, CVD risk factor (CVDRF) prevalence is evaluated across countries based on national income in the Africa and Middle East Region (AfME). Methods:Data from the Africa Middle East Cardiovascular Epidemiological (ACE) study were used; a cross-sectional study in 14 AfME countries (94 clinics) from July 2011-April 2012, which evaluated CVDRF prevalence in stable adult outpatients. World Bank definitions were used to classify countries as low-income (LI), lower-middle-income (LMI), upper-middle-income (UMI) or high-income (HI) countries. Four thousand three hundred seventy-eight subjects were recruited where 260 (6%), 1324 (30%), 1509 (35%) and 1285 (29%) were from LI, LMI, UMI, and HI countries, respectively. Results:Of all the CVDRFs evaluated, almost two-thirds of the study population across the national income groups had abdominal obesity and dyslipidemia. Countries in the HI category were associated with a higher prevalence of diabetes (32%), obesity (44%) and smoking (16%). UMI and HI countries were associated with higher clustering of CVDRFs where at least one-third of subjects having four or more CVDRFs. Lower income countries had lower blood pressure control rates and lower percentages of outpatients achieving LDL-cholesterol targets. Conclusion:The burden of CVDRFs in stable outpatients is high across the national income categories in the AfME region, with HI countries showing a higher prevalence of CVDRFs. The high burden in lower income countries is associated with sub-optimal control of dyslipidemia and hypertension. Lowering the CVDRF burden would need specific public health actions in line with positive changes in the macro-economy of these countries. Trial registration:The ACE trial is registered under NCT01243138.

SUBMITTER: Raal FJ

PROVIDER: S-EPMC5812200 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Cardiovascular risk factor burden in Africa and the Middle East across country income categories: a post hoc analysis of the cross-sectional Africa Middle East Cardiovascular Epidemiological (ACE) study.

Raal Frederick J FJ Alsheikh-Ali Alawi A AA Omar Mohamed I MI Rashed Wafa W Hamoui Omar O Kane Abdoul A Alami Mohamed M Abreu Paula P Mashhoud Walid M WM

Archives of public health = Archives belges de sante publique 20180212

<h4>Background</h4>A significant number of cardiovascular disease (CVD)-related deaths occur in developing countries. An increasing prevalence of CVD is associated with a change in the macro-economy of these countries. In this post hoc analysis, CVD risk factor (CVDRF) prevalence is evaluated across countries based on national income in the Africa and Middle East Region (AfME).<h4>Methods</h4>Data from the Africa Middle East Cardiovascular Epidemiological (ACE) study were used; a cross-sectional ...[more]

PMID: 29449941

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Project description:BackgroundThe Zanzibar Ministry of Health and Social Welfare, concerned about mental health in the country, requested technical assistance from WHO in 1997.AimsThis article describes the facilitation over many years by a WHO Collaborating Centre, of sustainable mental health developments in Zanzibar, one of the poorest countries in the world, using systematic approaches to policy design and implementation.MethodsBased on intensive prior situation appraisal and consultation, a multi-faceted set of interventions combining situation appraisal to inform planning; sustained policy dialogue at Union and state levels; development of policy and legislation, development of strategic action plans, establishment of intersectoral national mental health implementation committee, establishment of national mental health coordination system, integration of mental health into primary care, strengthening of primary-secondary care liaison, rationalisation and strengthening of secondary care system, ensuring adequate supply of medicines, use of good practice guidelines and health information systems, development of services for people with intellectual disability, establishment of formal mechanism for close liaison between the mental health services and other governmental, non-governmental and traditional sectors, mental health promotion, suicide prevention, and research and development.ResultsThe policy and legislation introduced in 1999 have resulted in enhanced mental health activities over the ensuing decade, within a setting of extreme low resource. However, advances ebb and flow and continued efforts are required to maintain progress and continue mental health developments. Lessons learnt have informed the development of mental health policies in neighbouring countries.ConclusionsA multi-faceted and comprehensive programme can be effective in achieving considerable strengthening of mental health programmes and services even in extremely low resource settings, but requires sustained input and advocacy if gains are to be maintained and enhanced.

Project description:BackgroundA relatively consistent body of literature, mainly from high-income countries, supports an inverse association between socio-economic status (SES) and risk of cardiovascular disease (CVD). Data from low- and middle-income countries are scarce. This study explores SES differences in cardiovascular health (CVH) in the Republic of Srpska (RS), Bosnia and Herzegovina, a middle-income country.MethodsWe collected information on SES (education, employment status and household's relative economic status, i.e. household wealth) and the 7 ideal CVH components (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and fasting blood glucose) among 3601 participants 25 years of age and older, from the 2010 National Health Survey in the RS. Based on the sum of all 7 CVH components an overall CVH score (CVHS) was calculated ranging from 0 (all CVH components at poor levels) to 14 (all CVH components at ideal levels). To assess the differences between groups the chi-square test, t-test and ANOVA were used where appropriate. The association between SES and CVHS was analysed with multivariate linear regression analyses. The dependent variable was CVHS, while independent variables were educational level, employment status and wealth index.ResultsAccording to multiple linear regression analysis CVHS was independently associated with education attainment and employment status. Participants with higher educational attainment and those economically active had higher CVHS (b = 0.57; CI = 0.29-0.85 and b = 0.27; CI = 0.10-0.44 respectively) after adjustment for sex, age group, type of settlement, and marital status. We failed to find any statistically significant difference between the wealth index and CVHS.ConclusionThis study presents the novel information, since CVHS generated from the individual CVH components was not compared by socio-economic status till now. Our finding that the higher overall CVHS was independently associated with a higher education attainment and those economically active supports the importance of reducing socio-economic inequalities in CVH in RS.

Project description:IntroductionLow-and Middle-Income Countries (LMICs) in the Middle East and North Africa (MENA) region are facing increasing global health challenges with a reduced ability to manage them. Global Health Capacity Building (GHCB) initiatives have the potential to improve health workforce performance and health outcomes, however little is known about the GHCB topics and approaches implemented in this region. This is the first systematic review of GHCB initiatives among LMICs in the MENA region.MethodsAn academic database search of Medline (OVID), PubMed, Scopus, Embase.com , and Open Grey was conducted for articles published between January 2009 and September 2019 in English. Next, a grey literature search following a recommended search framework was conducted. Reviewed records addressed a global health topic, had a capacity building component, looked at specific learning outcomes, and reflected an LMIC in the MENA. Primary outcomes included country, topic, modality, pedagogy, and population.ResultsReports of GHCB initiatives were retrieved from grey sources (73.2%) and academic sources (26.8%). Most GHCB initiatives were mainly conducted face-to-face (94.4%) to professional personnel (57.5%) through a theoretical pedagogical approach (44.3%). Dominant global health themes were non-communicable diseases (29.2%), sexual and reproductive health (18.4%), and mental health (14.5%). When matched against the Global Burden of Disease data, important gaps were found regarding the topics of GHCB initiatives in relation to the region's health needs. There were limited reports of GHCB initiatives addressing conflict and emergency topics, and those addressing non-communicable disease topics were primarily reported from Egypt and Iran.ConclusionInnovative and practicum-based approaches are needed for GHCB initiatives among LMICs in the MENA region, with a focus on training community workers. Regional and country-specific analyses of GHCB initiatives relative to their health needs are discussed in the manuscript based on the results of this review.

Dataset Information

Cardiovascular risk factor burden in Africa and the Middle East across country income categories: a post hoc analysis of the cross-sectional Africa Middle East Cardiovascular Epidemiological (ACE) study.

Publications

Cardiovascular risk factor burden in Africa and the Middle East across country income categories: a post hoc analysis of the cross-sectional Africa Middle East Cardiovascular Epidemiological (ACE) study.

Similar Datasets

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