High blood pressure among adolescents in Africa: A systematic review and meta-analysis protocol.

INTRODUCTION: As high blood pressure (HBP) is often considered an adult disease in Africa, studies on and services for HBP focus on adults to the near-exclusion of adolescents. The dearth of information about the burden of HBP does not favour much attention being paid to it. We, therefore, prepared this protocol to estimate the prevalence and awareness of HBP in adolescents in Africa through a systematic review and meta-analysis. METHODS: We will search several major databases for published and unpublished articles on population-based studies on adolescents living in Africa, aged 10-19 years produced from the year 2000 to date. The included articles will be those that define HBP according to international guidelines using the blood pressure cut-offs of the 95th percentile for age, sex and height or of 130/90 mmHg, depending on the age of the subjects. The study selection as well as the evaluation of the quality of the included articles will be done independently by two reviewers, in line with best practices. We will pool together the prevalence across studies using random effects analysis and assess heterogeneity using meta-regression analysis and sub-group analysis. Sensitivity analysis using a leave-one-out analysis and an evaluation of reporting bias will also be performed. Reporting of our findings will conform to the recommended reporting guidelines. CONCLUSION: The findings from our comprehensive systematic review and meta-analysis will provide an up-to-date information on the prevalence of HBP and its awareness among adolescents in Africa and its sub-regions. They could be used to advocate for increased priority to life course approach to the prevention of cardiovascular diseases. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020197946.

Screening of hypertension, risks, knowledge/awareness in second-cycle schools in Ghana. A national cross-sectional study among students aged 12-22.

In Ghana, the management of hypertension in primary health care is a cost-effective way of addressing premature deaths from vascular disorders that include hypertension. There is little or no evidence of large-scale studies on the prevalence, risk, and knowledge/awareness of hypertension in students aged 12-22 years in Ghana. In a cross-sectional study, blood pressure, anthropometric indices, and knowledge/awareness assessment of students at second-cycle schools were recorded from 2018 to 2020 in three regions of Ghana. Multistage cluster sampling was used in selecting regions and the schools. Prevalence of prehypertension and hypertension was categorized by the Joint National Committee 7, where appropriate, chi-square, scatter plots, and correlations were used in showing associations. A total of 3165 students comprising 1776 (56.1%) females and 1389 (43.9%) males participated in this study within three regions of Ghana. The minimum age was 12 years and the maximum age was 22 years. The mean age was 17.21 with standard deviation (SD: 1.59) years. A 95% confidence interval was set for estimations and a P value < 0.05 was set as significant. The prevalence rate of overall hypertension was 19.91% and elevated (prehypertension) was 26.07%. Risk indicators such as weight, BMI, waist circumference, physical activity, and form of the diet were positively correlated with hypertension. Among Ghanaian students currently in second-cycle educational institutions, 19.91% were hypertensive and 26.07% were prehypertensive. This may indicate a probable high prevalence of hypertension in the future adult population if measures are not taken to curb the associated risks.

Language and Communication Impact of Hypertension: A Qualitative Study.

Background. Hypertension (HTN) is the second main source of outpatient morbidity in Ghana, and the understanding of a disease is necessary for its prevention and management. Language and communication are contributing factors to HTN in Ghana. No studies have been conducted to assess knowledge/awareness of HTN (in the context of its understanding) among students in Ghana. Following a local name for HTN in Ghana, researchers interviewed students through a focus group to assess their understanding/perception (meaning, cause, and prevention) of the disease. Available literature has concerned itself with clients' knowledge of their condition (diagnosis) rather than their comprehension of the true nature of what HTN is. The objective of this study is to assess the knowledge/awareness of HTN in the context of its understanding of the meaning, perception, causes, and prevention of hypertension among students of Ghana's Senior High School (Second Cycle). Semistructured interviews with the use of the theme lists were employed. Focus group conversations and interviews were held in the local Akan (Twi) language, which was later translated, interpreted, and analyzed. Overall, 25 second-cycle students participated. 60% were between 15 and 17 years, 24% were ≥18 years, and 16% were <15 years of age. Males were 44% and females were 56%. Students gave diverse perceptions of their knowledge of HTN. The local language's translation of HTN has influenced and affected its meaning/understanding among some, thus affecting their perception of causes and prevention.

The Impact of Video-Based Educational Interventions on Cervical Cancer, Pap Smear and HPV Vaccines.

Background: Video-based interventions have the potential to contribute to long-lasting improvements in health-seeking behaviours. Ghana's upsurge rate of information and communication technology usage presents an opportunity to improve the awareness of HPV vaccination and screening rates of cervical cancer among women in Ghana. This research aimed to assess the impact of video-based educational intervention centred on the Health Belief and Transtheoretical Models of behavioural changes in promoting HPV vaccination, cervical carcinoma awareness and willingness to have Pap smear test (PST) among women in Ghana. Methods: To achieve the intended sample size, convenient, purposive and stratified random sampling techniques were used. SPSS v. 23.0 was used in the data analysis. Percentages and frequencies were used to represent participants' demographic characteristics, knowledge of (1) cervical carcinoma, (2) human papillomavirus vaccine, and (3) Pap smear test. The chi-square test by McNemar was employed to evaluate variations in the post- and pre-intervention responses. A p-value < 0.05 was considered statistically significant. The level of significance was adjusted owing to multiple comparisons by using the Bonferroni's correction. Results: Before the intervention, 84.2% of the participant had some knowledge or information about cervical cancer, but after the intervention, 100% of the participant became aware of cervical cancer which represents 15.8% increment at a P < .001. The willingness to have a pap smear test increased from 35.8% to 94.2% (df = 58.4%, P < .001) after the educational intervention. The willingness to be vaccinated increased from 47.5% to 81.7% (df = 34.2%, P < .001) after the educational intervention. Six months after the intervention, participants were followed-up. 253 (42.2%) participants had gone for cervical cancer screening (Pap smear test) while 347 (57.8%) participants had not been screened. In terms of HPV vaccination, 192 participants (32.0%) had begun their HPV vaccination cycle. Conclusion: The study results show that health education, using videos, may be influential in perception changing, self-efficacy improvement and the understanding of cervical carcinoma screening and HPV vaccination.

Evidence of rotavirus vaccine impact in sub-Saharan Africa: Systematic review and meta-analysis.

BACKGROUND: Over 34 countries in Africa have introduced rotavirus vaccine to their national immunization programs: monovalent (Rotarix®, RV1) and pentavalent (RotaTeq®, RV5) after South Africa introduced it in 2009. Since then several studies assessing the impact of the vaccine have been conducted. The principal aim of this study was to evaluate the impact of rotavirus vaccine in sub-Saharan Africa. METHODS: A Literature search was performed using Mendeley, PubMed, ScienceDirect, grey literature and Web of Science databases of published studies from January 1, 2017, as years of recent publications on rotavirus vaccine impact in sub-Saharan Africa. A meta-analysis was conducted for rotavirus infection in children under 5 years using proportions of pre and post-vaccine introduction in these populations. Random-effect estimates were considered since the samples were from universal populations. RESULTS: Out of the 935 articles identified, 17 studies met the inclusion for systematic review and meta-analysis. The pooled proportion for pre-vaccination period was 42%, 95% (CI: 38-46%), and reduced to 21%, 95% (CI: 17-25%) during post-vaccination period. Rotavirus diarrhea significantly reduced in children < 12 months as compared to children 12-24 months old. Seasonal peaks of rotavirus diarrhea were between June-September. However, data is limited to one year of post-vaccine introduction, and bias may present due to early vaccine impact. CONCLUSION: We observed that the introduction of the rotavirus vaccine was partly responsible for the significant reduction in the burden of rotavirus-associated diarrhea in sub-Saharan Africa. Therefore, there is a need to encourage the remaining countries to introduce the vaccine to their routine national immunization programs.

Preference for High Dietary Salt Intake Is Associated With Undiagnosed Type 2 Diabetes: The Henan Rural Cohort.

Background: Diabetes continues to be a serious disease burden globally. Nutrition plays a vital role in human life and health, and both inadequate and over nutrition have been implicated in cause the of disease. Objective: We explored the role of preference for high dietary salt intake and diabetes in a rural population. We also looked at possible mediating factors in the relationship between diabetes and preference for high dietary salt intake. Methods/Participants: Data from the Henan rural cohort in China were analyzed. Using multinomial regression models, the association between diabetes diagnosis type and reported preference for dietary salt was assessed. Adjusted odds ratios (aORs) with confidence interval (CI) at a 95% level are reported. Mediation analyses using structural equation models in Stata were performed. Results: Of the 39,183 participants included in the analyses, 4.07% were previously diagnosed with diabetes, and 5.80% with undiagnosed diabetes. Eighteen percent had a preference for salty meals, the mean age was 55.45 years, and 60% were women. Preference for salty meals was associated with undiagnosed diabetes (aOR = 1.17, 95% CI 1.03, 1.32), but not with previously diagnosed diabetes. Stratified analysis revealed that the association with undiagnosed diabetes was only significant in men (aOR = 1.36, 95% CI 1.13, 1.70) but not in women (aOR = 1.06, 95% CI 0.81, 1.38). BMI and central obesity fully mediated the association. Dietary salt intake was self-reported and therefore presents a limitation. Conclusion: Our study demonstrated that preference for high dietary salt intake is associated with undiagnosed diabetes but not prevalent diabetes.

Depressive symptoms are not associated with type 2 diabetes in a rural population in China: findings from the Henan rural cohort.

BACKGROUND: Depression is one of the most prevalent mental health challenges that affect all groups of persons. This study examines the association between type 2 diabetes and depressive symptoms (using PHQ-2) in a rural population. Other risk factors of depressive symptoms are examined. METHODS: Data from 30,001 participants from the Henan rural cohort was analyzed. Multivariable logistic regression analyses were performed to examine the associations between depressive symptoms (DS) and type 2 diabetes and other risk factors. Adjusted odds ratios (aOR) with confidence intervals (CI) at 95% are reported. RESULTS: The prevalence of DS in the study population is 5.86%, 6.69% in women, 4.74% in men, 5.80% in persons without diabetes and 6.81% in persons with diabetes (diagnosed and undiagnosed). DS prevalence was highest in persons with previously diagnosed diabetes (8.27%). No association was found between DS and diabetes (aOR = 0.95, CI at 95% 0.61-1.48; p=0.836). DS was associated with poor glycemic control (aOR=1.43, CI at 95% 1.04- 1.98; p= 0.034) in persons with previously diagnosed diabetes, persons with elevated triglycerides (aOR=1.19, CI at 95% 1.08-1.30; p<0.001), household income (aOR= 0.78, CI at 95% 0.63-0.97; p=0.027), marital status (aOR=1.37, CI at 95% 1.01-1.88, p=0.049) and hypertension treatment with medication (aOR=1.94, CI at 95% 1.48-2.55; p<0.001). LIMITATIONS: DS was assessed through self-report and may suffer recall or information bias. CONCLUSIONS: DS was not associated with diabetes in our study population. The association between poor glycemic control and DS calls for the integration of screening for depression among patients with diabetes.

Infection Prevention and Control Preparedness Level and Associated Determinants in 56 Acute Healthcare Facilities in Ghana.

BACKGROUND: Infection prevention and control (IPC) is a globally relevant aspect of all health systems impacting the health and safety of both patients and healthcare workers. However, best practices remain a challenge in healthcare delivery especially in resource limited situations. The primary objective of this study was to assess the infection prevention and control (IPC) preparedness levels of acute healthcare facilities in Ghana and to determine the factors associated with the overall IPC preparedness levels in acute healthcare facilities. METHODS: A cross-sectional study adapting the IPC assessment framework (IPCAF) developed by the World Health Organization (WHO) was conducted. Five of the core components of the WHO IPCAF were used to assess the IPC level of 56 acute healthcare facilities in Ghana. RESULTS: Of the 56 facilities surveyed, only 19 had an IPC program with clearly defined objectives. Overall, 8 (14.3%) facilities scored an IPC preparedness level of "Advance", 18 (32.1%) facilities received an "Intermediate" IPC preparedness score, 23 (41.1%) facilities received an IPC preparedness level of "basic" and 7 (12.5%) facilities scored an IPC preparedness level of "inadequate". IPC materials like detergents, running water and PPEs were not significantly supplied. Government owned facilities performed better in terms of IPC preparedness as compared to privately owned facilities. A PLUM-ordinal regression analysis revealed that an IPC program with clearly defined objectives (OR= 76; 95% CI; 7.23, 808.19), dedicated IPC budget (OR= 13; 95% CI; 3.8-44.3) and regular mandatory training (OR= 50.9; 95% CI; 6.1-425) were associated with increased IPC preparedness. CONCLUSION: Generally, the IPC preparedness levels in a majority of the facilities were low and required significant improvements in several areas. Facilities must make periodic reviews and adjust their objectives based on facility priorities.

Hand Hygiene Habits of Ghanaian Youths in Accra.

The human palm has been identified as one of the richest habitats for human microbial accommodation making hand hygiene essential to primary prevention of infection. Since the hand is in constant contact with fomites which have been proven to be mostly contaminated, building hand hygiene habits is essential for the prevention of infection. This research was conducted to assess the hand hygiene habits of Ghanaian youths in Accra. This study used a survey as a quantitative method of research. The findings of the study revealed that out of the 254 participants who fully answered the questionnaire, 22% had the habit of washing their hands after outings while only 51.6% had the habit of washing their hands after using the bathroom. However, about 60% of the participants said they sometimes ate with their hands while 28.9% had the habit of eating with the hand very often, a situation that put them at risk of infection from their hands since some participants had poor handwashing habits; prompting the need for continuous education on hand hygiene.

A cross-sectional study of risk factors and hypertension among adolescent Senior High School students.

INTRODUCTION: Hypertension is among the first five causes of mortality, globally contributing more than 40% to cardiac related deaths worldwide, with almost 70% cardiovascular deaths in the low- and middle-income countries. Its burden is projected to be 150 million by 2025 based on epidemiological data within the Sub-Saharan Africa regions, with Ghana experiencing 505,180 increases in 2007. It is currently among the leading cause of death in the country, with prevalence ranging from 19% to 48%. There is limited data concerning hypertension on Ghanaian youth. Particularly, on those at the Senior High School (SHS) level that represents the immediate workforce of the country on the depth of prevalence, knowledge as well as the risk factors that may predispose them into having prehypertension and hypertension for proper records and interventional measures and that is what this study pursues to do. MATERIALS AND METHODS: A cross-sectional study was employed in five different SHSs in the Ashanti region of Ghana from December 2018 to February 2019 with structured questionnaires and physical screening of participants. Logistic regression analysis was performed to test for relation knowledge and riskfactors on HTN. RESULTS: The overall prevalence of pre-HTN within the group was 33.8%, with stages 1 and 2 HTN prevalence of 5.4%. Sixty-three percent do not have an idea of what HTN is, and positive associations were found between no physical exercises, no addition of extra salt, type of food often eaten and family history. CONCLUSION: This study establishes prevalence in pre-HTN within students at the SHS level with low knowledge and high risk factors on the disease. This indication is beneficial to target the interventional programs on this population at this early stage by inculcating education on HTN prevalence and its risks in the educational curricular by the government.

Survival outcomes and efficacy of autologous CD19 chimeric antigen receptor-T cell therapy in the patient with diagnosed hematological malignancies: a systematic review and meta-analysis.

Purpose: Chimeric Antigen Receptor T(CAR-T) cell therapy is an immunotherapy approach used in treating cancer which has seen rapid development over the decades. It becomes the preferred treatment choice after patients have failed conventional chemotherapy. Methods: We conducted a meta-analysis in 320 patients from 14 studies to estimate the survival outcome, response rate and toxicity of autologous CD19 CAR-T cell therapy and predict other factors associated with a better prognosis. Results: The overall response rate was 71.88% (95% CI: 61.34-80.46%, p<0.01) and CRS toxicity was 60.15% (95% CI: 42.87-75.22%, p<0.01). Patients who received lymphodepletion was associated with a better response rate (77%, 95%CI: 67-83%; p-value =0.001) in comparison to the other patients who did not (66%, 95%CI: 41-83%). Conclusion: Lymphodepletion regimen may play a crucial role in predicting the prognosis of patients with hematological malignancies. Lymphodepletion patients had better progression-free survival than those who did not.