Cardiac arrhythmia services in Africa from 2011 to 2018: the second report from the Pan African Society of Cardiology working group on cardiac arrhythmias and pacing.

AIMS: Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa. METHODS AND RESULTS: Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations. CONCLUSION: The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa.

Cardiac Pacing in Sub-Saharan Africa: JACC International.

Many parts of the developing world, especially Sub-Saharan Africa, completely lack access to cardiac pacing. The authors initiated a multinational program to implement cardiac pacing in 14 countries in Sub-Saharan Africa (1996 to 2018), aiming to eventually build self-sustainable capacity in each country. This was based on an "on-site training" approach of performing procedures locally and educating local health care teams to work within resource-limited settings, with prospective evaluation of the program. In 64 missions, a total of 542 permanent pacemakers were implanted. In 11 of these countries, the first pacemaker implant in the country was through the mission. More than one-half of those initially listed as suitable died before the mission(s) arrived. The proportion of implantations that were completely handled by local teams increased from 3% in 1996 to 98% in 2018. These findings demonstrate the feasibility and effectiveness of a proctorship-based approach to the development of local cardiac pacing capabilities in Sub-Saharan African nations.

Right ventricular outflow tract tachycardia worsened during pregnancy.

We report the case of a 35 years old woman without underlying heart disease who was diagnosed with a right ventricular outflow tract tachycardia worsened during pregnancy. The diagnosis of ventricular tachycardia was made early in her pregnancy course but the patient had symptoms three months earlier. Her disease course was marked by rhythmic storms during the second trimester of pregnancy that led to three hospitalizations accounting for about two weeks in total. The combination of nadolol 80 mg and flecainide tablets 150 mg improved her rhythmic storms. Radiofrequency allowed a radical cure of this ventricular tachycardia. The patient is now asymptomatic 27 months after radiofrequency treatment.

Les démences en afrique subsaharienne : aspects cliniques et étiologiques en milieu hospitalier à ouagadougou (burkina faso)

Description En Afrique subsaharienne; l'amelioration progressive des conditions de vie a pour corollaire l'emergence accrue de certaines pathologies en rapport avec l'age dont la demence. L'objectif de cette etude etait de decrire les differents aspects des demences au Centre Hospitalier Universitaire Yalgado Ouedraogo. Methode C'est une etude transversale qui a inclus pendant deux ans les sujets ages de plus de 15 ans hospitalises ou ayant consulte dans les services de Neurologie; Psychiatrie; Cardiologie et Neurochirurgie et repondant aux criteres diagnostiques de demence du DSM-IV. Resultats Soixante-douze demences ont ete diagnostiquees soit une prevalence hospitaliere de 4;55 pour mille patients et 2;21des patients hospitalises. L'age moyen etait de 62;20 ans avec un sex ratio de 2. L'installation des troubles cognitifs et comportementaux a ete insidieuse et progressive dans la plupart des cas. La demence etait severe avec un score MMS inferieur a 9 dans la majorite des cas. Les demences secondaires dites curables etaient les plus frequentes (68;05); dominees par les demences vasculaires et les causes neurochirurgicales. Seulement 18des demences etaient degeneratives avec a leur tete les demences de type Alzheimer. L'entourage familial reste fortement implique dans la demarche de soins et la prise en charge Conclusion La demence est une realite au Burkina Faso; avec une prevalence sous-estimee. Il est donc necessaire de mener des etudes en population dans le but d'envisager des mesures preventives et de prise en charge adaptees a notre contexte

Hypertension, urbanization, social and spatial disparities: a cross-sectional population-based survey in a West African urban environment (Ouagadougou, Burkina Faso).

Data show that hypertension has become a public health problem in developing countries. Many studies have reported social disparities among the affected populations, but few of them pointed out spatial disparities within towns. We aimed to show that hypertension could be a good indicator of the medical change that occurs unequally in towns. A cross-sectional survey was done in April and October 2004 in Ouagadougou, Burkina Faso, among 2087 adults over 35 years old in different kinds of urban areas. Social and demographic data were collected and blood pressure was measured. Prevalence of hypertension was 40.2%. Age, body mass index, level of equipment, absence of community integration, absence of occupation, duration of residence over 20 years, protein-rich diet and absence of physical activity were identified as risk factors, but there were social and spatial disparities according to location of housing (parcelled-out or non-parcelled-out areas) and to integration within the town. The high rate of hypertension found in Ouagadougou and the heterogeneity of the risk within the population highlights that social and spatial risk factors have to be taken into account for the prevention of the non-transmissible diseases in countries in full process of urbanization and medical change.

[Validation of a method of blood pressure measurement for a study of hypertension in a black African population]. / Validation de la méthode de mesure de la tension artérielle pour une enquête en population sur l'hypertension artérielle chez le Noir Africain.

Hypertension is a major public health issue in Black Africa. It is also an important factor of cardiovascular risk. To determine the prevalence of hypertension in a large population in Burkina Faso, it is more practicable to use an automatic device for the measurement of BP. Before the start of the study, we tested the reliability of an automatic technique for the measurement of BP in sitting position according to the reference technique. The manometer of reference was a manual, aneroid, and calibrated manometer. The automatic manometer was oscillometric, validated according to the protocol of the British Hypertension Society. The study was held on voluntary healthy persons, or patients hospitalized in the cardiology department of the national university hospital of Ouagadougou (high blood pressure, valvulopathy, cardiac insufficiency). BP measurement was made in a sequential way, with the manual manometer, and with the automatic manometer, by a single observer. Measurement by the manual manometer was based on the auscultation of Korotkoff's murmurs. Systolic blood pressure (SBP) corresponded to phase I, and diastolic blood pressure (DBP) to phase V. Measurement by the automatic manometer was made by reading the BP shown on the device screen. The 10.0 version of the SPSS software was used for data analysis. Statistical tests were concluded with a risk of 0.05. Confidence intervals included 95% of the subjects. The percentage comparison of hypertensive subjects observed in the population by both methods was made with a paired khi2 test. We used Pearson's correlation to quantify the relation between the measures taken using the two methods. In order to quantify the degree of agreement of the two methods, we used the intraclass correlation coefficient (ICC) for quantitative BP measurements, and Kappa's coefficient for qualitative measurements (determination of normotensive or hypertensive subjects). The study was held on 50 black African subjects, with the average age of 38.54 4.83 (18 years-77 years); 55% were male subjects. With the reference method in the sleeping position, the mean SBP and DBP values were respectively 122.60 8.52 and 70.36 5.22 mmHg. The minimal and maximal SBP observed were 80 and 240 mmHg respectively, and the DBP, 30 and 130 mmHg respectively. With the automatic method in the sitting position, the mean values SBP and DBP was 119.88+7.50 and 74.80 4.36 mmHg. SBP minimal was of 75, the maximal of 210 mmHg, and the minimal and maximal DBP was respectively 51 and 121 mmHg. Pearson's correlation coefficients for SBP and DBP between the two methods were statistically different from zero; 0.92 (p<0.001), and of 0.82 (p<0.001) respectively. The ICC was 0.91 for SBP and 0.78 for DBP. Kappa's coefficient was calculated to estimate agreement for the determination of normotensive or hypertensive subjects; among the 50 subjects, 36 were classified normotensive by the two methods, and eight, hypertensive. The differences of classification concerned five hypertensive subjects and one normotensive subject, according to the referenced method. Kappa's coefficient was 0.65. The distribution of the subjects in hypertensive and normotensive did not differ significantly in the two methods (p=0.22). The agreement between the two methods was found very good for the measurement of SBP and DBP; it was good for the determination of an hypertensive or normotensive subject. It is important to test the reliability of a technique of BP measurement before the evaluation of hypertension prevalence in a large population. The reliability of the technique ensures a good estimation of the disease prevalence. It is also important to use statistically adapted tests, to avoid any wrong conclusion as to the reliability of the technique.

[Intensive care in Africa: a report of the first two years of activity of the intensive care unit of Ouagadougou national hospital (Burkina Faso)]. / Soins intensifs en Afrique: expérience des deux premières années d'activité du service de réanimation du centre hospitalier national de Ouagadougou (Burkina Faso).

OBJECTIVE: Intensive care units (ICUs) are very expensive and their role and effectiveness in developing countries are discussed; yet, their performance in these countries was infrequently reported. We report the experience over the first two years of activity of the multidisciplinary intensive care unit of the Ouagadougou national hospital. The analysis of such experience raises the issues related to intensive care in a developing country in terms of technical and social efficiency. DESIGN: Retrospective study of medical records. SETTING: Multidisciplinary ICUs of a national teaching hospital. The eleven million inhabitants of Burkina Faso are one the poorest nations in the world (3rd in UNDP classification). The Yalgado Ouedraogo national hospital is the largest in the country and the only one in the capital city, Ouagadougou; this national referral and teaching hospital has 724 beds. The ICU was created in December 1996; it has 8 beds, equipped with ventilators, monitors and various instruments. The staff consists of two full-time anesthesiologists and three others who contribute to the duty system, one senior nurse, two nurses specialized in anesthesia and fourteen other nurses. The unit is open to medical students and student nurses for hospital-based training. PATIENTS: All patients admitted in 1997 and 1998. MEASUREMENTS AND MAIN RESULTS: Data was collected from medical records and related to length of stay (LOS), morbidity, mortality, therapy and patients' socio-demographic background. No severity score was given. Three hundred and thirty-eight patients, mainly males (73%), were admitted; the average bed occupancy rate was 25%. The average age of patients was 39.05 +/- 1.21; there was no sex-specific age difference. Distribution as per socio-professional category showed a high proportion of civil servants (38.0%); farmers (23.7%) and housewives (17.6%) were relatively few. Admission diagnoses included 146 traumas (43.2%) of which 105 cranial traumas, 121 post operative (35.8%) and 71 medical pathologies (21.0%). Forty-nine patients (14.5%) were mechanically ventilated. The average LOS was 4.69 0.42 days; half of the patients stayed under 48 hours. The overall mortality rate was 63.6%. The rate was 79% for medical pathologies, 70.5% for traumas and 48.5% for post operative patients. The LOS was significantly longer in survivors (7.24 +/- 1.02) than in deceased (3.54 +/- 0.38). The cumulative survival curve showed a high death probability density which decreased in time: 0.74 on the first day, 0.58 on the second, 0.36 on the sixth. The mortality rate was higher in ventilated patients than in non-ventilated ones. The highest mortality rate was observed among senior civil servants and farmers, and the lowest among craftsmen. The analysis of the first two years of operation of the ICUs of Ouagadougou national hospital reveals a low bed occupancy and a high mortality rate, particularly in the first days and for farmers. These results provide an opportunity to suggest the need for reorganization, with special emphasis on personnel availability and training, and for improved affordability of intensive care services.