Estimated Impact of Achieving the Australian National Sodium Reduction Targets on Blood Pressure, Chronic Kidney Disease Burden and Healthcare Costs: A Modelling Study.

Excess sodium intake raises blood pressure which increases the risk of chronic kidney disease (CKD). We aimed to estimate the impact of reduced sodium intake on future CKD burden in Australia. A multi-cohort proportional multistate lifetable model was developed to estimate the potential impact on CKD burden and health expenditure if the Australian Suggested Dietary Target (SDT) and the National Preventive Health Strategy 2021-2030 (NPHS) sodium target were achieved. Outcomes were projected to 2030 and over the lifetime of adults alive in 2019. Achieving the SDT and NPHS targets could lower population mean systolic blood pressure by 2.1 mmHg and 1.7 mmHg, respectively. Compared to normal routines, attaining the SDT and NPHS target by 2030 could prevent 59,220 (95% UI, 53,140-65,500) and 49,890 (44,377-55,569) incident CKD events, respectively, while postponing 568 (479-652) and 511 (426-590) CKD deaths, respectively. Over the lifetime, this generated 199,488 health-adjusted life years (HALYs) and AUD 644 million in CKD healthcare savings for the SDT and 170,425 HALYs and AUD 514 million for the NPHS. CKD due to hypertension and CKD due to other/unspecified causes were the principal contributors to the HALY gains. Lowering sodium consumption in Australia could deliver substantial CKD health and economic benefits.

Burden of atrial fibrillation among adults with heart failure in sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to estimate the prevalence of atrial fibrillation (AF) in adults with heart failure (HF) and summarise the all-cause mortality ratio among adult patients with coexisting HF and AF in sub-Saharan Africa (SSA). SETTING: This was a systematic review and meta-analysis of cross-sectional and cohort studies with primary data on the prevalence and incidence of AF among patients with HF and the all-cause mortality ratio among patients with HF and AF in SSA. We combined text words and MeSH terms to search MEDLINE, PubMed and Global Health Library through Ovid SP, African Journals Online and African Index Medicus from database inception to 10 November 2021. Random-effects meta-analysis was used to estimate pooled prevalence. PRIMARY OUTCOME MEASURES: The prevalence and incidence of AF among patients with HF, and the all-cause mortality ratio among patients with HF and AF. RESULTS: Twenty-seven of the 1902 records retrieved from database searches were included in the review, totalling 9987 patients with HF. The pooled prevalence of AF among patients with HF was 15.6% (95% CI 12.0% to 19.6%). At six months, the all-cause mortality was 18.4% (95% CI 13.1% to 23.6%) in a multinational registry and 67.7% (95% CI 51.1% to 74.3%) in one study in Tanzania. The one-year mortality was 48.6% (95% CI 32.5% to 64.7%) in a study in the Democratic Republic of Congo. We did not find any study reporting the incidence of AF in HF. CONCLUSION: AF is common among patients with HF in SSA, and patients with AF and HF have poor survival. There is an urgent need for large-scale population-based prospective data to reliably estimate the prevalence, incidence and risk of mortality of AF among HF patients in SSA to better understand the burden of AF in patients with HF in the region. PROSPERO REGISTRATION NUMBER: CRD42018087564.

High Urban-Rural Inequities of Abdominal Obesity in Malawi: Insights from the 2009 and 2017 Malawi Noncommunicable Disease Risk Factors Surveys.

Geographical disparities in abdominal obesity (AO) exist in low-income countries due to major demographic and structural changes in urban and rural areas. We aimed to investigate differences in the urban-rural prevalence of AO in the Malawi population between 2009 and 2017. We conducted a secondary analysis of data from the Malawi 2009 and 2017 STEPS surveys. AO (primary outcome) and very high waist circumference (secondary outcome) were defined using WHO criteria. Prevalence estimates of AO and very high waist circumference (WC) were standardized by age and sex using the age and sex structure of the adult population in Malawi provided by the 2018 census. A modified Poisson regression analysis adjusted for sociodemographic covariates was performed to compare the outcomes between the two groups (urban versus rural). In total, 4708 adults in 2009 and 3054 adults in 2017 aged 25-64 were included in the study. In 2009, the age-sex standardized prevalence of AO was higher in urban than rural areas (40.9% vs 22.0%; adjusted prevalence ratio [aPR], 1.51; 95% confidence interval [CI], 1.36-1.67; p < 0.001). There was no significant trend for closing this gap in 2017 (urban 37.0% and rural 21.4%; aPR, 1.48; 95% CI, 1.23-1.77; p < 0.001). This urban-rural gap remained and was slightly wider when considering the 'very high WC' threshold in 2009 (17.0% vs. 7.1%; aPR, 1.98; 95%CI, 1.58-2.47; p < 0.001); and in 2017 (21.4% vs. 8.3%; aPR, 2.03; 95%CI, 1.56-2.62; p < 0.001). Significant urban-rural differences exist in the prevalence of AO and very high WC in Malawi, and the gap has not improved over the last eight years. More effective weight management strategies should be promoted to reduce health care disparities in Malawi, particularly in urban areas.

Avoidable burden of stomach cancer and potential gains in healthy life years from gradual reductions in salt consumption in Vietnam, 2019-2030: a modelling study.

OBJECTIVE: Excess salt consumption is causally linked with stomach cancer, and salt intake among adults in Vietnam is about twice the recommended levels. The aim of this study was to quantify the future burden of stomach cancer that could be avoided from population-wide salt reduction in Vietnam. DESIGN: A dynamic simulation model was developed to quantify the impacts of achieving the 2018 National Vietnam Health Program (8 g/d by 2025 and 7 g/d by 2030) and the WHO (5 g/d) salt reduction policy targets. Data on salt consumption were obtained from the Vietnam 2015 WHO STEPS survey. Health outcomes were estimated over 6-year (2019-2025), 11-year (2019-2030) and lifetime horizons. We conducted one-way and probabilistic sensitivity analyses. SETTING: Vietnam. PARTICIPANTS: All adults aged ≥ 25 years (61 million people, 48·4 % men) alive in 2019. RESULTS: Achieving the 2025 and 2030 national salt targets could result in 3400 and 7200 fewer incident cases of stomach cancer, respectively, and avert 1900 and 4800 stomach cancer deaths, respectively. Achieving the WHO target by 2030 could prevent 8400 incident cases and 5900 deaths from stomach cancer. Over the lifespan, this translated to 344 660 (8 g/d), 411 060 (7 g/d) and 493 633 (5 g/d) health-adjusted life years gained, respectively. CONCLUSIONS: A sizeable burden of stomach cancer could be avoided, with gains in healthy life years if national and WHO salt targets were attained. Our findings provide impetus for policy makers in Vietnam and Asia to intensify salt reduction strategies to combat stomach cancer and mitigate pressure on the health systems.

The avoidable disease burden associated with overweight and obesity in Kenya: A modelling study.

Background: Globally, there is a rising burden of non-communicable diseases related to high body mass index (BMI). Estimation of the magnitude of the avoidable disease burden related to high BMI in Kenya could inform priority setting in health. Methods: Using a proportional multistate life table model, we estimated the impact of the elimination of exposure to high BMI (>22·5 kg/m2) on health adjusted life years, health adjusted life expectancy, and burden of 27 obesity-related diseases. Participants were the 2019 Kenyan population modelled over their remaining lifetime. Findings: Elimination of high BMI could save approximately 83·5 million health-adjusted life years and increase the health-adjusted life expectancy by 2·3 (95% UI 2·0-2·8) years for females and 1·0 (95% UI 0·8-1·1) years for males. Over the first 25 years, over 7·4 million new cases of BMI-related diseases could be avoided and approximately half a million BMI related deaths postponed. The cumulative number of new cases of type 2 diabetes could reduce by approximately 1·6 million, cardiovascular diseases by over 1·3 million, chronic kidney disease by 850,473 and cancer would reduce by 55,624 estimated cases. In 2044, an estimated 867,664 prevalent cases of musculoskeletal disease would be prevented. Interpretation: The magnitude of avoidable high BMI-related disease burden in Kenya underscores the need to prioritise the control and prevention of overweight and obesity globally, especially in low- and middle-income settings, where obesity rates are rising rapidly. Reducing population BMI is challenging, but sustained and well-enforced system-wide approaches could be a great starting point. Funding: Mary Njeri Wanjau is supported by the Griffith University International Postgraduate Research Scholarship (GUIPRS) and Griffith University Postgraduate Research Scholarship (GUPRS).

Dietary Salt Reduction, Prevalence of Hypertension and Avoidable Burden of Stroke in Vietnam: Modelling the Health and Economic Impacts.

Dietary salt reduction has been recommended as a cost-effective population-wide strategy to prevent cardiovascular disease. The health and economic impact of salt consumption on the future burden of stroke in Vietnam is not known. Objective: To estimate the avoidable incidence of and deaths from stroke, as well as the healthy life years and healthcare costs that could be gained from reducing salt consumption in Vietnam. Methods: This was a macrosimulation health and economic impact assessment study. Data on blood pressure, salt consumption and stroke epidemiology were obtained from the Vietnam 2015 STEPS survey and the Global Burden of Disease study. A proportional multi-cohort multistate lifetable Markov model was used to estimate the impact of achieving the Vietnam national salt targets of 8 g/day by 2025 and 7 g/day by 2030, and to the 5 g/day WHO recommendation by 2030. Probabilistic sensitivity analysis was conducted to quantify the uncertainty in our projections. Results: If the 8 g/day, 7 g/day, and 5 g/day targets were achieved, the prevalence of hypertension could reduce by 1.2% (95% uncertainty interval [UI]: 0.5 to 2.3), 2.0% (95% UI: 0.8 to 3.6), and 3.5% (95% UI: 1.5 to 6.3), respectively. This would translate, respectively, to over 80,000, 180,000, and 257,000 incident strokes and over 18,000, 55,000, and 73,000 stroke deaths averted. By 2025, over 56,554 stroke-related health-adjusted life years (HALYs) could be gained while saving over US$ 42.6 million in stroke healthcare costs. By 2030, about 206,030 HALYs (for 7 g/day target) and 262,170 HALYs (for 5 g/day target) could be gained while saving over US$ 88.1 million and US$ 122.3 million in stroke healthcare costs respectively. Conclusion: Achieving the national salt reduction targets could result in substantial population health and economic benefits. Estimated gains were larger if the WHO salt targets were attained and if changes can be sustained over the longer term. Future work should consider the equity impacts of specific salt reduction programs.

Stakeholder perceptions of current practices and challenges in priority setting for non-communicable disease control in Kenya: a qualitative study.

OBJECTIVE: To explore the stakeholders' perceptions of current practices and challenges in priority setting for non-communicable disease (NCD) control in Kenya. DESIGN: A qualitative study approach conducted within a 1-day stakeholder workshop that followed a deliberative dialogue process. SETTING: Study was conducted within a 1-day stakeholder workshop that was held in October 2019 in Nairobi, Kenya. PARTICIPANTS: Stakeholders who currently participate in the national level policymaking process for health in Kenya. OUTCOME MEASURE: Priority setting process for NCD control in Kenya. RESULTS: Donor funding was identified as a key factor that informed the priority setting process for NCD control. Misalignment between donors' priorities and the country's priorities for NCD control was seen as a hindrance to the process. It was identified that there was minimal utilisation of context-specific evidence from locally conducted research. Additional factors seen to inform the priority setting process included political leadership, government policies and budget allocation for NCDs, stakeholder engagement, media, people's cultural and religious beliefs. CONCLUSION: There is an urgent need for development aid partners to align their priorities to the specific NCD control priority areas that exist in the countries that they extend aid to. Additionally, context-specific scientific evidence on effective local interventions for NCD control is required to inform areas of priority in Kenya and other low-income and middle-income countries. Further research is needed to develop best practice guidelines and tools for the creation of national-level priority setting frameworks that are responsive to the identified factors that inform the priority setting process for NCD control.

Estimation and determinants of direct medical costs of ischaemic heart disease, stroke and hypertensive heart disease: evidence from two major hospitals in Cameroon.

BACKGROUND: Cardiovascular disease (CVD) is the largest contributor to the non-communicable diseases (NCD) burden in Cameroon, but data on its economic burden is lacking. METHODS: A prevalence-based cost-of-illness study was conducted from a healthcare provider perspective and enrolled patients with ischaemic heart disease (IHD), ischaemic stroke, haemorrhagic stroke and hypertensive heart disease (HHD) from two major hospitals between 2013 and 2017. Determinants of cost were explored using multivariate generalized linear models. RESULTS: Overall, data from 850 patients: IHD (n = 92, 10.8%), ischaemic stroke (n = 317, 37.3%), haemorrhagic stroke (n = 193, 22.7%) and HHD (n = 248, 29.2%) were analysed. The total cost for these CVDs was XAF 676,694,000 (~US$ 1,224,918). The average annual direct medical costs of care per patient were XAF 1,395,200 (US$ 2400) for IHD, XAF 932,700 (US$ 1600) for ischaemic stroke, XAF 815,400 (US$ 1400) for haemorrhagic stroke, and XAF 384,300 (US$ 700) for HHD. In the fully adjusted models, apart from history of CVD event (ß = - 0.429; 95% confidence interval - 0.705, - 0.153) that predicted lower costs in patients with IHD, having of diabetes mellitus predicted higher costs in patients with IHD (ß = 0.435; 0.098, 0.772), ischaemic stroke (ß = 0.188; 0.052, 0.324) and HHD (ß = 0.229; 0.080, 0.378). CONCLUSIONS: This study reveals substantial economic burden due to CVD in Cameroon. Diabetes mellitus was a consistent driver of elevated costs across the CVDs. There is urgent need to invest in cost-effective primary prevention strategies in order to reduce the incidence of CVD and consequent economic burden on a health system already laden with the impact of communicable diseases.

Cost-effectiveness analysis of population salt reduction interventions to prevent cardiovascular disease in Cameroon: mathematical modelling study.

BACKGROUND: Reducing dietary sodium (salt) intake has been proposed as a population-wide strategy to reduce blood pressure and cardiovascular disease (CVD). The cost-effectiveness of such strategies has hitherto not been investigated in Cameroon. METHODS: A multicohort multistate life table Markov model was used to evaluate the cost-effectiveness of three population salt reduction strategies: mass media campaign, school-based salt education programme and low-sodium salt substitute. A healthcare system perspective was considered and adults alive in 2016 were simulated over the life course. Outcomes were changes in disease incidence, mortality, health-adjusted life years (HALYs), healthcare costs and incremental cost-effectiveness ratios (ICERs) over the lifetime. Probabilistic sensitivity analysis was used to quantify uncertainty. RESULTS: Over the life span of the cohort of adults alive in Cameroon in 2016, substantial numbers of new CVD events could be prevented, with over 10 000, 79 000 and 84 000 CVD deaths that could be averted from mass media, school education programme and salt substitute interventions, respectively. Population health gains over the lifetime were 46 700 HALYs, 348 800 HALYs and 368 400 HALYs for the mass media, school education programme and salt substitute interventions, respectively. ICERs showed that all interventions were dominant, with probabilities of being cost-saving of 84% for the school education programme, 89% for the mass media campaign and 99% for the low sodium salt substitute. Results were largely robust in sensitivity analysis. CONCLUSION: All the salt reduction strategies evaluated were highly cost-effective with very high probabilities of being cost-saving. Salt reduction in Cameroon has the potential to save many lives and offers good value for money.

Health-related quality of life and its determinants in patients with chronic low back pain at a tertiary hospital in Cameroon: a cross-sectional study.

OBJECTIVE: To evaluate health-related quality of life (HRQoL) and its determinants in chronic low back pain (CLBP) patients in Cameroon. DESIGN: Observational cross-sectional study. SETTING: Tertiary hospital. PARTICIPANTS: There were 150 eligible adults with low back pain of at least 12 weeks who provided informed consent. Of these, 136 with complete questionnaires were analysed. OUTCOMES: HRQoL was measured using the WHO Quality of Life questionnaire (WHOQOL-BREF). Outcome measures included its four domain (physical health, psychological, social relationships and environmental) scores and two independent scores for overall quality of life (OQOL) and general health satisfaction (GH). RESULTS: Participants had a median age of 52 years, and median pain duration of 33 (IQR: 69) months. The median OQOL score was 50 (IQR: 25). After multivariable adjustment, tertiary education (ß=11.43, 95% CI 3.12 to 19.75), age (ß=0.49, 95% CI 0.12 to 0.87) and being a student (ß=23.07, 95% CI 0.28 to 45.86) contributed to better OQOL. Age (ß=0.57, 95% CI 0.10 to 1.04) and physical-type employment (ß=-14.57, 95% CI -25.83 to -3.31) affected GH. Smoking (ß=-20.49, 95% CI -35.49 to -5.48) and radiological anomalies (ß=-7.57, 95% CI -14.64 to -0.49) affected the physical health domain, while disability (ß=-0.67, 95% CI -1.14 to -0.20) and duration of pain (ß=-0.13, 95% CI -0.20 to -0.05) affected the psychological domain. Income (ß=14.94, 95% CI 4.06 to 25.81) affected the social domain, while education (ß=9.96, 95% CI 1.41 to 18.50) and disability (ß=-0.75, 95% CI -1.26 to -0.24) affected the environmental domain. CONCLUSIONS: Our findings suggest that CLBP affects HRQoL and multiple socioeconomic and clinical factors influence its impact on different domains of HRQoL. Multipronged management programmes, especially those that reduce disability, could improve HRQoL in patients with CLBP.

Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the Global Burden of Disease Study 2017.

BACKGROUND: Although the burden of disease in sub-Saharan Africa continues to be dominated by infectious diseases, countries in this region are undergoing a demographic transition leading to increasing prevalence of non-communicable diseases (NCDs). To inform health system responses to these changing patterns of disease, we aimed to assess changes in the burden of NCDs in sub-Saharan Africa from 1990 to 2017. METHODS: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to analyse the burden of NCDs in sub-Saharan Africa in terms of disability-adjusted life-years (DALYs)-with crude counts as well as all-age and age-standardised rates per 100 000 population-with 95% uncertainty intervals (UIs). We examined changes in burden between 1990 and 2017, and differences across age, sex, and regions. We also compared the observed NCD burden across countries with the expected values based on a country's Socio-demographic Index. FINDINGS: All-age total DALYs due to NCDs increased by 67·0% between 1990 (90·6 million [95% UI 81·0-101·9]) and 2017 (151·3 million [133·4-171·8]), reflecting an increase in the proportion of total DALYs attributable to NCDs (from 18·6% [95% UI 17·1-20·4] to 29·8% [27·6-32·0] of the total burden). Although most of this increase can be explained by population growth and ageing, the age-standardised DALY rate (per 100 000 population) due to NCDs in 2017 (21 757·7 DALYs [95% UI 19 377·1-24 380·7]) was almost equivalent to that of communicable, maternal, neonatal, and nutritional diseases (26 491·6 DALYs [25 165·2-28 129·8]). Cardiovascular diseases were the second leading cause of NCD burden in 2017, resulting in 22·9 million (21·5-24·3) DALYs (15·1% of the total NCD burden), after the group of disorders categorised as other NCDs (28·8 million [25·1-33·0] DALYs, 19·1%). These categories were followed by neoplasms, mental disorders, and digestive diseases. Although crude DALY rates for all NCDs have decreased slightly across sub-Saharan Africa, age-standardised rates are on the rise in some countries (particularly those in southern sub-Saharan Africa) and for some NCDs (such as diabetes and some cancers, including breast and prostate cancer). INTERPRETATION: NCDs in sub-Saharan Africa are posing an increasing challenge for health systems, which have to date largely focused on tackling infectious diseases and maternal, neonatal, and child deaths. To effectively address these changing needs, countries in sub-Saharan Africa require detailed epidemiological data on NCDs. FUNDING: Bill & Melinda Gates Foundation, National Health and Medical Research Centre (Australia).

Occurrence and challenges in the management of severe chronic plaque type psoriasis in a limited resourced setting: a case report.

Plaque-type psoriasis is a major dermatosis with significant effects on quality of life. Case complexity is often high in low-resourced settings such as in Africa where the incidence has been on the rise. Despite major advancements and newer therapeutic modalities over the last decade, an insight into the real-life, day to day challenges in low resourced settings reveal an interplay between the difficulty in obtaining these drugs and use of alternative traditional indigenous agents. We report the case of a 50 year old immunocompetent male who presented with chronic and extensive well demarcated plaques covered with silver-white scales occupying about 61% of his body surface area. Patient was however lost to follow up for about 8 months during which time, the lesions responded to some unknown homemade indigenous medications which was preferred to a systemic medication. Paramount importance on proper counselling and the need to retain patients in care is warranted by physicians and allied health personnel. Also, incentives aimed at subsidizing the newer systemic agents for patients in low resourced cohorts will go a long way to combat this multi-faceted disorder which is often unrecognized and under diagnosed.

Acute kidney injury as initial presentation of renal lymphoma: Diagnostic and therapeutic challenges in a resource-limited setting.

Non-Hodgkin's lymphoma is reportedly common in Africa; however, there is limited data on renal involvement. Acute kidney injury only at presentation is rare for lymphoproliferative malignancies. A 7-year old presented to our facility with a 2-week history of progressive abdominal distension and pain, examination revealed anasarca and hypertension. On further evaluation, there were bilateral nephromegaly, acute kidney injury (AKI) and cytomorphological findings suggestive of lymphoma. Patient management was mostly supportive, and evolution was unfavourable leading to his demise. We discuss diagnostic and therapeutic challenges due to unavailability of state-of-the-art facilities in resource-constrained settings.

Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon.

BACKGROUND: Diabetes mellitus is a growing cause of disease burden globally. Its management is multifaceted, and adherence to pharmacotherapy is known to play a significant role in glycaemic control. Data on medication adherence among affected patients is unknown in Cameroon. In this study, the level of adherence and factors influencing non-adherence to antidiabetic medication among patients with type-2 diabetes was assessed. METHODS: A hospital-based cross-sectional study among adult patients receiving care in the diabetic clinics of the Limbe and Bamenda Regional Hospitals in Cameroon was conducted. Medication adherence was assessed using the Medication Compliance Questionnaire (MCQ). Factors associated with non-adherence to medication were determined using basic and adjusted multivariable logistic regression models. RESULTS: A total of 195 patients with type 2 diabetes were recruited. The prevalence of non-adherence to medication was 54.4% [95% confidence interval (CI): 47.1-61.5%]. In multivariable analysis, age > 60 years (aO.R. = 0.48, 95% CI: 0.25-0.94), alcohol consumption (aO.R. = 2.13, 95% CI: 1.10-4.14) and insulin alone therapy (aO.R. = 2.85, 95% CI: 1.01-8.08) were associated with non-adherence. Patients attributed their non-adherence to forgetfulness (55.6%), lack of finances (38.2%) and disappearance of symptoms (14.2%). CONCLUSIONS: Adherence to anti-diabetic medication is poor in this study with more than half of participants being non-adherent. Urgent interventions are required to tackle this problem in combined efforts to stem this looming diabetes epidemic.

Potential impact of a modest reduction in salt intake on blood pressure, cardiovascular disease burden and premature mortality: a modelling study.

Objective: To assess the potential impact of reduction in salt intake on the burden of cardiovascular disease (CVD) and premature mortality in Cameroon. Methods: Using a multicohort proportional multistate life table model with Markov process, we modelled the impact of WHO's recommended 30% relative reduction in population-wide sodium intake on the CVD burden for Cameroonian adults alive in 2016. Deterministic and probabilistic sensitivity analyses were conducted and used to quantify uncertainty. Results: Over the lifetime, incidence is predicted to decrease by 5.2% (95% uncertainty interval (UI) 4.6 to 5.7) for ischaemic heart disease (IHD), 6.6% (95% UI 5.9 to 7.4) for haemorrhagic strokes, 4.8% (95% UI 4.2 to 5.4) for ischaemic strokes and 12.9% (95% UI 12.4 to 13.5) for hypertensive heart disease (HHD). Mortality over the lifetime is projected to reduce by 5.1% (95% UI 4.5 to 5.6) for IHD, by 6.9% (95% UI 6.1 to 7.7) for haemorrhagic stroke, by 4.5% (95% UI 4.0 to 5.1) for ischaemic stroke and by 13.3% (95% UI 12.9 to 13.7) for HHD. About 776 400 (95% UI 712 600 to 841 200) health-adjusted life years could be gained, and life expectancy might increase by 0.23 years and 0.20 years for men and women, respectively. A projected 16.8% change (reduction) between 2016 and 2030 in probability of premature mortality due to CVD would occur if population salt reduction recommended by WHO is attained. Conclusion: Achieving the 30% reduction in sodium intake recommended by WHO could considerably decrease the burden of CVD. Targeting blood pressure via decreasing population salt intake could translate in significant reductions in premature CVD mortality in Cameroon by 2030.

Atrial fibrillation among adults with heart failure in sub-Saharan Africa - prevalence, incidence and all-cause mortality: a systematic review and meta-analysis protocol.

INTRODUCTION: Heart failure (HF) remains a major non-communicable disease in sub-Saharan Africa (SSA) associated with high rates of readmission, mortality and loss of economic productivity as it affects mostly young and economically active adults. Atrial fibrillation (AFib) is a major determinant of mortality among patients with HF in SSA. Meanwhile, the use of anti-arrhythmic medications in the region remains unacceptably low. This review aims to evaluate the prevalence and incidence of AFib in adult patients with HF in SSA, and the all-cause mortality rate among patients with HF and AFib. METHODS AND ANALYSIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015 statement was used to prepare this protocol. All eligible studies from database inception to December, 31 2018 in MEDLINE, Embase, Google Scholar, Web of science and Africa-specific databases (AFROLIB, African Index Medicus and African Journals Online) will be included without language restrictions. The process of study screening, selection, data extraction and assessment of risk of bias will be conducted independently by two reviewers. Disagreements will be arbitrated by a third reviewer. Study-specific estimates will be pooled using random-effect meta-analysis and summary measures obtained will be presented in forest plots. The χ2 test on Cochrane's Q and the I2 statistics will be used to assess and quantify heterogeneity, respectively. The Egger's test and funnel plots will be used to assess publication bias. ETHICS AND DISSEMINATION: Since our review will be based on already published data, an ethical approval is not required. The findings of this review will be presented in conferences and peer-reviewed journals and shared on social media such as Researchgate, Facebook, WhatsApp and Twitter. PROSPERO REGISTRATION NUMBER: CRD42018087564.

Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa.

BACKGROUND: Very little is known about the burden of chronic low back pain in Africa. This study aimed at assessing disability and associated factors in chronic low back patients in Cameroon. METHODS: We carried a hospital-based cross-sectional study including patients suffering from low back pain (LBP) of at least 12 weeks' duration. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ). RMDQ > 4 described persons with dysfunctional levels of disability. Multivariable linear regression was used to investigate factors associated with higher RMDQ scores hence greater disability. Variables investigated included; gender, age, marital status, employment status and type, smoking history, alcohol consumption, income, pain intensity, LBP duration, psychological wellbeing, sleep satisfaction, leg pain, numbness/paresthesia, bowel/bladder dysfunction symptoms (BBDS), body mass index (BMI), and days of work absence. RESULTS: A sample of 136 adults (64% female) with a mean age of 50.6 ± 12.2 years participated in the study. Median duration of LBP was 33 (25th - 75th percentile: 12-81) months. Mean RMDQ score was 12.8 ± 6. In multivariable linear regression, pain intensity (ß = 0.07, p = 0.002), longer days of work absence (ß = 0.15, p = 0.003) and BBDS (ß =2.33, p = 0.029) were associated with greater disability. Factors such as consumption of alcohol (ß = - 3.55, p = 0.005) and higher psychological wellbeing scores (ß = - 0.10, p = 0.004) significantly contributed to less disability (lower RMDQ scores). Dysfunctional levels of disability were present in 88.1% of patients. CONCLUSION: CLBP is associated with significant disability and this relationship is driven by several factors. Multidisciplinary management strategies especially those targeted to improve pain control, manage BBDS and improve psychological wellbeing could reduce disability and improve quality of life.

Helicobacter pylori infection among patients presenting with dyspepsia at a primary care setting in Cameroon: seroprevalence, five-year trend and predictors.

BACKGROUND: Almost half the world's population is infected with Helicobacter pylori (H. pylori) with the highest reported prevalence from Africa. This infection is associated with several morbid gastrointestinal conditions. Understanding the trends in seroprevalence and the factors associated with H. pylori seropositivity in dyspeptic persons can provide a guide for public health policies. METHODS: This was a retrospective study, carried out with outpatient records of Wum District Hospital (WDH) from January 2012 to December 2016. We reviewed records of all patients for whom a H. pylori serology test was requested. The Cochran-Armitage trend test and multiple regression models were used to explore seroprevalence trends and predictors of seropositivity respectively. RESULTS: We included 451 records, 63.6% (n = 287) were female. The mean age of the study population was 40.7 years, and the overall H. pylori seroprevalence was 51.5% (95% CI: 47-56%). The use of recommended eradication regimen appears to be low and declining. On average, H. pylori seroprevalence declined by 6.8% annually (p < 0.0001). Occupational status independently predicted seropositivity, with students having lower odds of being seropositive than employed persons (aOR = 0.09, 95% CI: 0.02-0.49, p = 0.016). CONCLUSION: Despite decreasing trends, the seroprevalence of Helicobacter pylori infection is high in dyspeptic patients attending this primary care setting. Improving living standards and establishing national guidelines for eradication can possibly aid the control of this infection.

A diagnostic algorithm for pulmonary hypertension due to left heart disease in resource-limited settings: can busy clinicians adopt a simple, practical approach?

Pulmonary hypertension (PH) has progressively moved from an orphan disease to a significant global health problem with a major disease burden in limited7hyphen;resource countries, where over 97% of patients live. The aetiologies of PH differ between high- and low-income nations, but PH due to left heart disease is credited to be the most frequent contemporary form. Although a straightforward diagnosis of PH requires the use of right heart catheterisation (RHC), access to equipment for RHC is a deterrent. Furthermore, the risk associated with RHC limits its uptake to a selection of specialised centres. Moreover, the rigour and clinical reasoning for diagnosis in clinical medicine is rapidly changing and revealing that PH can complicate a diverse range of medical conditions needing other explorations. In this article, we provide for the busy clinician, a simplified diagnostic algorithm for PH that is relevant for making a correct early diagnosis and limiting the impact of PH.

Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: a systematic review and meta-analysis of cohort studies.

BACKGROUND: In 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers. METHODS: Cohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger's test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309). RESULTS: Eleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I2 = 99.7; P = 0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR = 0.56, 95% CI = 0.37 to 0.84), abdominal injuries (RR = 0.87; 95% CI = 0.78 to 0.98) and, spinal injuries (RR = 0.56, 95% CI = 0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR = 0.49; 95% CI = 0.22 to 1.08), neck injuries (RR = 0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR = 1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR = 0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers. CONCLUSION: In sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type.