Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017.

BACKGROUND: Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence, and disability-adjusted life-years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease, and other nonrheumatic valvular diseases were estimated for 195 countries and territories from 1990 to 2017. METHODS: Vital registration data, epidemiologic survey data, and administrative hospital data were used to estimate disease burden using the Global Burden of Disease Study modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimate disease for all countries, because data on nonrheumatic valvular diseases are extremely limited for some regions of the world, such as Sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for both sexes and each 5-year age group, location, and year from 1990 to 2017. RESULTS: Globally, CAVD and degenerative mitral valve disease caused 102 700 (95% uncertainty interval [UI], 82 700-107 900) and 35 700 (95% UI, 30 500-42 500) deaths, and 12.6 million (95% UI, 11.4 million-13.8 million) and 18.1 million (95% UI, 17.6 million-18.6 million) prevalent cases existed in 2017, respectively. A total of 2.5 million (95% UI, 2.3 million-2.8 million) DALYs were estimated as caused by nonrheumatic valvular diseases globally, representing 0.10% (95% UI, 0.09%-0.11%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and degenerative mitral valve disease between 1990 and 2017 by 101% (95% UI, 79%-117%) and 35% (95% UI, 23%-47%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries. CONCLUSIONS: These global and national estimates demonstrate that CAVD and degenerative mitral valve disease are important causes of disease burden among older adults. Efforts to clarify modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.

Translation, cross-cultural adaptation and psychometric evaluation of yoruba version of the short-form 36 health survey.

BACKGROUND AND OBJECTIVE: The Short-Form Health Survey (SF-36) is a valid quality of life tool often employed to determine the impact of medical intervention and the outcome of health care services. However, the SF-36 is culturally sensitive which necessitates its adaptation and translation into different languages. This study was conducted to cross-culturally adapt the SF-36 into Yoruba language and determine its reliability and validity. METHODS: Based on the International Quality of Life Assessment project guidelines, a sequence of translation, test of item-scale correlation, and validation was implemented for the translation of the Yoruba version of the SF-36. Following pilot testing, the English and the Yoruba versions of the SF-36 were administered to a random sample of 1087 apparently healthy individuals to test validity and 249 respondents completed the Yoruba SF-36 again after two weeks to test reliability. Data was analyzed using Pearson's product moment correlation analysis, independent t-test, one-way analysis of variance, multi trait scaling analysis and Intra-Class Correlation (ICC) at p < 0.05. RESULTS: The concurrent validity scores for scales and domains ranges between 0.749 and 0.902 with the highest and lowest scores in the General Health (0.902) and Bodily Pain (0.749) scale. Scale-level descriptive result showed that all scale and domain scores had negative skewness ranging from -2.08 to -0.98. The mean scores for each scales ranges between 83.2 and 88.8. The domain scores for Physical Health Component and Mental Health Component were 85.6 ± 13.7 and 85.9 ± 15.4 respectively. The convergent validity was satisfactory, ranging from 0.421 to 0.907. Discriminant validity was also satisfactory except for item '1'. The ICC for the test-retest reliability of the Yoruba SF-36 ranges between 0.636 and 0.843 for scales; and 0.783 and 0.851 for domains. CONCLUSION: The data quality, concurrent and discriminant validity, reliability and internal consistency of the Yoruba version of the SF-36 are adequate and it is recommended for measuring health-related quality of life among Yoruba population.

Prevalence and modes of complementary and alternative medicine use among peasant farmers with musculoskeletal pain in a rural community in South-Western Nigeria.

BACKGROUND: Anecdotally, use of Complementary and Alternative Medicine (CAM) for Musculoskeletal Pain (MSP) is common in Nigeria; however, there seems to be a dearth of empirical data on its prevalence and mode of use. This study investigated the prevalence and modes of use of CAM for MSP among farmers in a rural community in South-western Nigeria. METHODS: This cross-sectional survey employed multistage sampling technique guidelines for conducting community survey by the World Health Organization among rural community farmers in Gudugbu village, Oyo State, Nigeria. A questionnaire developed from previous studies and validated by expert reviews was used to assess prevalence and modes of CAM use. Data was analyzed using descriptive and inferential statistics. Alpha level was set at p < 0.05. RESULTS: A total of 230 consenting rural farmers volunteered for this study with a valid response rate of 93.9 % (n = 216). The lifetime, 12-month and point prevalence of CAM for MSP was 96.8 % respectively. Herbal therapy and massage were the predominant types of CAM therapies among previous (83.8 and 80.1 %) and current CAM users (37.5 and 37.5 %). CAM was largely used as sole therapy for MSP (75.5 %) and also in combination with orthodox medicine (23.6 %), and it is consumed on daily basis (21.8 %). CAM was perceived to be very good in maintaining a healthy life (87.1 %) and has less side effects (74 %) and more healthy than taking doctors' prescriptions (63.4 %). CONCLUSION: There is a high prevalence of CAM among Nigerian rural farmers. The most commonly employed CAM for MSP were herbal remedies and massage which are attributable to beliefs on their perceived efficacy.

Equivalence in Active Pharmaceutical Ingredient of Generic Antihypertensive Medicines Available in Nigeria (EQUIMEDS): A Case for Further Surveillance.

BACKGROUND: Widespread access to good quality antihypertensive medicines is a critical component for reducing premature cardiovascular disease (CVD) mortality. Poor-quality medicines pose serious health concerns; however, there remains a knowledge gap about the quality of cardiovascular medicines available in low- and middle-income countries. OBJECTIVES: The aim of this study was to determine the quality of generic antihypertensive medicines available in the retail market of a developing country. METHODS: Samples of the 2 most commonly prescribed classes of antihypertensive medicines were collected from 3 states in 3 different geopolitical zones in Nigeria following a semirandom sampling framework. Medicine samples were purchased by mystery shoppers from 22 pharmacy outlets from 6 local government areas across the 3 states. Medicine quality was determined by measuring the amount of stated active pharmaceutical ingredient using high-performance liquid chromatography with photodiode array detection and classified according to their compliance to the specified pharmacopeia tolerance limits for each antihypertensive drug. RESULTS: Amlodipine and lisinopril were identified as the most commonly prescribed antihypertensive drugs in Nigeria. In total, 361 samples from 22 pharmacies were collected and tested. In total, 24.6% of amlodipine and 31.9% of lisinopril samples were of substandard quality and significantly more samples purchased in rural (59 of 161, 36.7%) compared with urban (32 of 200, 16%) outlets were found to be of substandard quality (p < 0.001). No falsified samples of either amlodipine or lisinopril were detected. There was large variation in price paid for the antihypertensive medicines (range ₦150 to ₦9,750). Of the 24 pharmacy outlets surveyed, 46% stated that patients did not always require a prescription and 21% had previously reported a medicine as falsified or substandard. CONCLUSIONS: More than one-quarter of some commonly prescribed antihypertensive medicines available in Nigeria may be of substandard quality. Enhanced quality assurance processes in low- and middle-income countries, such as Nigeria, are needed to support optimum management.

Physical activity profile of Nigeria: implications for research, surveillance and policy.

Appraising the status of physical activity surveillance, research and policy in Nigeria is relevant to national and regional public health actions on physical activity promotion and non-communicable disease control. This study aimed to 1) evaluate the physical activity profile of Nigeria and 2) propose strategies for improving physical activity in the country. The Global Observatory for Physical Activity-GoPA! with inputs from local experts systematically collected sociodemographic and physical activity surveillance, national policy and research indicators data for Nigeria in 2014. The Nigerian Country Card highlighting the status of these indicators was developed in 2015 and launched in 2016. Prevalence of physical activity among Nigerian adults was 78% (female=76%, male=79%). There was no physical activity surveillance system and national plan, and no empirical data on the proportion of all deaths directly due to physical inactivity in Nigeria. Few (n=7) articles related to physical activity and public health were published in 2013 and the country occupied the 38th position in the global research ranking, contributing about 0.24% to physical activity research worldwide. Implementing national physical activity plans and multi-sectorial collaborations between government and non-governmental partners are needed to improve physical activity surveillance, research and policy in Nigeria and other African countries with similar physical activity gaps.

Physicochemical equivalence of generic antihypertensive medicines (EQUIMEDS): protocol for a quality of medicines assessment.

BACKGROUND: Prevention and optimal management of hypertension in the general population is paramount to the achievement of the World Heart Federation (WHF) goal of reducing premature cardiovascular disease (CVD) mortality by 25% by the year 2025 and widespread access to good quality antihypertensive medicines is a critical component for achieving the goal. Despite research and evidence relating to other medicines such as antimalarials and antibiotics, there is very little known about the quality of generic antihypertensive medicines in low-income and middle-income countries. The aim of this study was to determine the physicochemical equivalence (percentage of active pharmaceutical ingredient, API) of generic antihypertensive medicines available in the retail market of a developing country. METHODS: An observational design will be adopted, which includes literature search, landscape assessment, collection and analysis of medicine samples. To determine physicochemical equivalence, a multistage sampling process will be used, including (1) identification of the 2 most commonly prescribed classes of antihypertensive medicines prescribed in Nigeria; (2) identification of a random sample of 10 generics from within each of the 2 most commonly prescribed classes; (3) a geographical representative sampling process to identify a random sample of 24 retail outlets in Nigeria; (4) representative sample purchasing, processing to assess the quality of medicines, storage and transport; and (5) assessment of the physical and chemical equivalence of the collected samples compared to the API in the relevant class. In total, 20 samples from each of 24 pharmacies will be tested (total of 480 samples). DISCUSSION: Availability of and access to quality antihypertensive medicines globally is therefore a vital strategy needed to achieve the WHF 25×25 targets. However, there is currently a scarcity of knowledge about the quality of antihypertensive medicines available in developing countries. Such information is important for enforcing and for ensuring the quality of antihypertensive medicines.

Incidence and pattern of cardiovascular disease in a Nigerian teaching hospital.

Epidemiological data on cardiovascular disorders are generally lacking in the developing nations. The aim of this study was to assess the five years' incidence and pattern of cardiovascular disease in a Nigerian Teaching Hospital. The records of patients diagnosed as having various cardiovascular disorders between 1997 and 2001 were scrutinized. Data such as age, sex, diagnosis, length of hospitalization and status at discharge (dead or alive) were obtained. A total number of 1104 patients were recorded. Heart failure (35%) followed by hypertension (32%) was found to be the most prevalent.

Comparative functional exercise capacity of patients with type 2-diabetes and healthy controls: a case control study.

INTRODUCTION: Functional Exercise Capacity (FEC) is a valid measure of physical fitness in health and disease. However, there is paucity of studies on FEC in African patients with Type-2 Diabetes (T2D). This study compared FEC between patients with T2D and healthy controls. METHODS: Thirty five patients with T2D (18 men, 17 women) and 35 (16 men, 19 women) age-sex matched healthy controls participated in this case-control study. Anthropometric and demographic characteristics and cardiovascular parameters were measured following standard procedures. A glucometer was used to determine the Fasting Blood Glucose (FBG) level following at least 8 hours of overnight fasting. FEC was assessed using the Six-Minute Walk Test (6MWT) while Hand Grip Strength (HGS) test was measured with an electronic dynamometer. Data were analyzed using descriptive and inferential statistics. Alpha level was set at p< 0.05. RESULTS: Patients with T2D and controls were similar in age (p > 0.05). There were significant differences in the distance covered during 6MWT between patients and controls (t= 0.329; p =0.03), exercise capacity (t = 0.329; p = 0.03), FBG (t = 7.403; p = 0.001), systolic and diastolic blood pressure (t = 12.56; p = 0.001 and t = 27.23; p = 0.001) respectively. There were significant inverse relationships between 6MWD and Body mass index (r = -0.39; p = 0.02) and FBS(r = -0.51; p = 0.02) in patients with type-2 respectively. No significant association was found between exercise capacity and HGS (p > 0.05). CONCLUSION: Patients with type-2 diabetes demonstrated lower functional exercise capacity than healthy controls. High body mass index and fasting blood glucose were significantly associated with lower functional exercise capacity.