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Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies.

ABSTRACT: BACKGROUND:Uncontrolled hypertension is one of the major risk factors of cardiovascular and cerebrovascular diseases. The prevalence of hypertension in Ethiopia is expected to reach up to 30%. The aim of this study was to determine the prevalence of uncontrolled hypertension among hypertensive patients on treatment in Ethiopia. METHODS:Electronic databases and search engines including EMBASE (Ovid), PubMed/Medline, and Google Scholar were searched for original records in the English language addressing hypertension control in Ethiopia from 2000 to 2018. Data were extracted using a format prepared in Microsoft Excel and exported to STATA 15.0 software for analyses. The study protocol is registered at PROSPERO with reference number ID: CRD42018116336. RESULTS:A total of 13 studies with 5226 hypertension patients were included for systematic review and meta-analysis. The pooled prevalence of uncontrolled hypertension in Ethiopia was 48% (95% confidence interval (CI): 36, 61%). The result of the sub-group analysis, based on the year of publications, revealed that the prevalence of uncontrolled BP was highest in 2016 (63%; CI: 60, 67%) and in 2015 (59%; CI: 53, 65%). Univariate meta-regression revealed that sampling distribution was not a source of heterogeneity for the pooled estimate as well as the sub group analysis. CONCLUSION:The prevalence of uncontrolled hypertension was high in Ethiopia. This alarming public health issue fuels the ever-increasing cardiovascular and cerebrovascular diseases. The ministry of health has to design a policy and implementation mechanisms to reduce uncontrolled hypertension prevalence and improve awareness on blood pressure control.

SUBMITTER: Amare F

PROVIDER: S-EPMC7066819 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies.

Amare Firehiwot F Hagos Bisrat B Sisay Mekonnen M Molla Bereket B

BMC cardiovascular disorders 20200311 1

<h4>Background</h4>Uncontrolled hypertension is one of the major risk factors of cardiovascular and cerebrovascular diseases. The prevalence of hypertension in Ethiopia is expected to reach up to 30%. The aim of this study was to determine the prevalence of uncontrolled hypertension among hypertensive patients on treatment in Ethiopia.<h4>Methods</h4>Electronic databases and search engines including EMBASE (Ovid), PubMed/Medline, and Google Scholar were searched for original records in the Engli ...[more]

PMID: 32160859

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Project description:BACKGROUND:Self-medication is the use of drugs to treat self-diagnosed disorders and/or symptoms, or the intermittent or continued use of a prescribed drug for recurrent disease or symptoms. This phenomenon is alarmingly increasing over time despite the occurrence of health-related hazards. This study is, therefore, aimed to quantitatively estimate self-medication practice and possible reasons for it in Ethiopia. METHODS:Data were identified from major databases and indexing services including EMBASE (Ovid), PubMed, MEDLINE (Ovid), and Google Scholar. Both published and unpublished records addressing self medication practice in Ethiopia without time limit were included for the study. Data were extracted with structured format prepared in Microsoft Excel and exported to OpenMeta[analyst] version 3.3 software for analyses. Pooled estimation of outcomes was performed with DerSimonian-Laird random-effects model at 95% confidence level. Sensitivity and subgroup analyses were also considered. Degree of heterogeneity of studies was presented with I2 statistics. Publication bias was also performed with the help of Comprehensive Meta-Analysis version-3 software and presented with funnel plots of standard error supplemented by Begg's and Egger's tests. The study protocol is registered on PROSPERO with reference number ID: CRD42018093790. RESULTS:A total of 27 studies with 9586 participants were included for the study. The pooled prevalence of self-medication in Ethiopia was found to be 44.0% (95% confidence interval [CI]: 35.1, 52.8). Geographical-based subgroup analysis revealed that the highest prevalence was observed at the capital of Ethiopia, Addis Ababa, 62.8% (95% CI: 42.3, 83.2). Population based analysis indicated that healthcare professionals and students were the main practitioners of self-medication. Besides, the prevalence of self-medication practice in pregnant women is approximately 22.9% (95% CI: 9.8, 36). The most common reasons to practice self-medication were previous experience of clients and/or familiarity of treatments, 31.3% (95% CI: 21.5, 41.1) and perceived mildness of the illness, 31.1% (95% CI: 26.0, 36.2). The pooled prevalence of analgesics, antimicrobial agents and gastrointestinal drugs were 46.1% (95% CI: 36.2, 56.1), 28.2% (95% CI: 19.6, 36.8), and 14.9% (95% CI: 7.8, 21.9), respectively. CONCLUSION:Self-medication practice becomes a common phenomenon in Ethiopia. The use of prescription-only medications including antimicrobial agents without medical consult has become alarmingly high. This practice will come with potential health related hazards including emergence of antimicrobial resistance. Therefore, there must be a multitude of strategies for reversing the current worrying trends of self-medication.

Project description:BACKGROUND:Unintended pregnancy has significant consequences for the health and welfare of women and children. Despite this, a number of studies with inconsistent findings were conducted to reduce unintended pregnancy in Ethiopia; unavailability of a nationwide study that determines the prevalence of unintended pregnancy and its determinants is an important research gap. Thus, this study was conducted to determine the overall prevalence of unintended pregnancy and its determinants in Ethiopia. METHODS:We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. Each of the original studies was assessed using a tool for the risk of bias of observational studies. The heterogeneity of studies was also assessed using I2 test statistics. Data were pooled and a random effect meta-analysis model was fitted to provide the overall prevalence of unintended pregnancy and its determinants in Ethiopia. In addition, the subgroup analyses were performed to investigate how the prevalence of unintended pregnancy varies across different groups of studies. RESULTS:Twenty-eight studies that satisfy the eligibility criteria were included. We found that the overall prevalence of unintended pregnancy in Ethiopia was 28% (95% CI: 26-31). The subgroup analyses showed that the highest prevalence of unintended pregnancy was observed from the Oromiya region (33.8%) followed by Southern Nations Nationalities and Peoples' region (30.6%) and the lowest was in Harar. In addition, the pooled prevalence of unintended pregnancy was 26.4% (20.8-32.4) and 30.0% (26.6-33.6) for community-based cross-sectional and institution-based cross-sectional studies respectively. The pooled analysis showed that not communicating with one's husband about family planning was more likely to lead to unintended pregnancy (OR: 3.56, 95%CI: 1.68-7.53). The pooled odds ratio also showed that unintended pregnancy is more likely among women who never use family planning methods (OR: 2.08, 95%CI: 1.18-3.69). Furthermore, the narrative review of this study showed that maternal education, age, and household wealth index are strongly associated with an unintended pregnancy. CONCLUSIONS:In this study, the prevalence of unintended pregnancy was high. Lack of spousal communication, never using family planning, maternal education, and household wealth level were significantly associated with an unintended pregnancy. This study implies the need to develop plans and policies to improve the awareness of contraceptive utilization and strengthen spousal communication related to pregnancy.

Project description:BackgroundBirth asphyxia accounted for nearly 50% of neonatal mortality in Sub-Saharan African countries. This scenario has been worst in Ethiopia where every two out of three deaths attributed to birth asphyxia. Moreover, studies conducted in Ethiopia were highly variable and inconclusive to estimate the pooled prevalence and determinants of perinatal birth asphyxia among preterm babies.ObjectiveThis study aimed to estimate the pooled prevalence of birth asphyxia and its determinants among preterm newborns in Ethiopia.MethodsThe protocol for this review is registered at PROSPERO with registration number CRD42020158224. A comprehensive online databases (PubMed, HINARI, Scopus, EMBASE, Science direct, and Cochrane library database), Google Scholar, African Journals online, other gray and online repository accessed studies will be searched using different search engines. In addition, maternity and infant care databases uploaded at Ethiopian Health Development Journal and Ethiopian Journal of Health Sciences will be searched until 30 June 2020. Newcastle-Ottawa Quality Assessment Scale (NOS) will be used for critical appraisal of studies. Three reviewers will screen all retrieved articles, conduct data extraction, and then critically appraise all identified studies. All identified observational studies reporting the prevalence of birth asphyxia and associated factors among neonates in Ethiopia will be considered. The analysis of data will be done using STATA 11.0. We will demonstrate pooled estimates and determinants of birth asphyxia with effect size and 95% confidence interval. Heterogeneity among the included studies will be assessed through the Cochrane Q test statistics and I2 test. Publication bias will be checked using funnel plot and Egger's test. Finally, statistical significance level will be declared at a p value of less than 0.05.DiscussionThe result from this systematic review will inform and guide health policy planners to invest limited resources on maternal and neonatal health. Furthermore, it will be a stimulus for future cumulative meta-analysis researchers in developing nations.

Project description:Introduction: Hypertension is one of the major risk factors to human health and human studies on association between gut microbiota and hypertension or blood pressure have received increased attention. In the present study, we aim to evaluate gut microbiota dysbiosis in human hypertension using a method of systematic review. Methods: PubMed, EMBASE, and Web of Science databases were searched until March 2021 to identify eligible articles. Additional articles were also identified by searching specific authors in this field. Inclusion criteria were observational studies based on stool samples with hypertension group and control group. Newcastle-Ottawa quality assessment scale (NOS) was used to assess the quality of the included studies. PROSPERO registration number: CRD42020212219. Results: A total of 17 studies enrolling 9,085 participants were included. Fifteen of the enrolled studies showed good quality and two studies showed fair quality based on NOS. We found alpha diversity in hypertension decreased significantly and microbial structure can be separated compared with control groups. Gut microbiota of hypertension showed depletion of short chain fatty acids (SCFAs) producers and over-growth of some Proteobacteria and Bacteroidetes members. Up-regulation of lipopolysaccharide biosynthesis, phosphotransferase system, ABC transporters, etc. and down-regulation of some amino acid metabolism, etc. in hypertension were reported. Fecal SCFAs levels increased and plasma SCFAs levels decreased in hypertension. Stronger microbial interactions in hypertension were seen. Conclusion: In conclusion, gut microbiota dysbiosis was observed in hypertension, including decreased diversity, altered microbial structure, compositional change of taxa, alterations of microbial function, nutritional and immunological factors, and microbial interactions. Poor absorption and high excretion of SCFAs may play an important role in the pathogenesis of hypertension. These findings may provide insights into etiology study and new microbial-based therapies of hypertension. Systematic Review Registration: PROSPERO database, identifier CRD42020212219.

Project description:Objectives We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions. Methods Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework. Results A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 increase in BMI. There was evidence of a J-shaped non-linear dose–response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22–24, and a 1.5–2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40–45). The SRR was 1.28 (95% CI 1.17 to 1.40, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively. Conclusion Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths. Trial registration number CRD42020218115.

Dataset Information

Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies.

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Uncontrolled hypertension in Ethiopia: a systematic review and meta-analysis of institution-based observational studies.

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