Hypertension in Mozambique: trends between 2005 and 2015

To assess the current prevalence, awareness, treatment and control of arterial hypertension in Mozambican population, including adolescents and young adults, and to appraise their trends over the past decade, for the 25­64 years old population. A cross-sectional study of a representative sample of the population aged 15­64 years (n = 2965) was conducted in 2014­2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Data from a survey conducted in 2005 using the same methodological approach was used to assess trends in the age group of 25­64 years. The prevalence of hypertension increased significantly, from 33.1 to 38.9% (P = 0.048), whereas awareness (2005 vs. 2014­2015: 14.8 vs. 14.5%, P = 0.914) and treatment among the aware (2005 vs. 2014­2015: 51.9 vs. 50.1%, P = 0.770) remained similar. Control among the treated increased (from 39.9 to 44.5%, P = 0.587), although not significantly. Mean blood pressure values increased (SBP: from 132.1 to 134.6 mmHg, P = 0.089; DBP: from 78.2 to 82.5 mmHg, P < 0.001). Among participants aged 15­24 years, in 2014­2015 the prevalence of hypertension was 13.1% (95% confidence interval: 9.8­16.4). Our findings show that the prevalence of hypertension in Mozambique is among the highest in developing countries, both in adults and adolescents, portraying an ample margin for reduction of the morbidity and mortality burden because of high blood pressure.

Hypertension in Mozambique: trends between 2005 and 2015

To assess the current prevalence, awareness, treatment and control of arterial hypertension in Mozambican population, including adolescents and young adults, and to appraise their trends over the past decade, for the 25­64 years old population. Methods: A cross-sectional study of a representative sample of the population aged 15­64 years (n = 2965) was conducted in 2014­2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Data from a survey conducted in 2005 using the same methodological approach was used to assess trends in the age group of 25­64 years. Results: The prevalence of hypertension increased significantly, from 33.1 to 38.9% (P = 0.048), whereas awareness (2005 vs. 2014­2015: 14.8 vs. 14.5%, P = 0.914) and treatment among the aware (2005 vs. 2014­2015: 51.9 vs. 50.1%, P = 0.770) remained similar. Control among the treated increased (from 39.9 to 44.5%, P = 0.587), although not significantly. Mean blood pressure values increased (SBP: from 132.1 to 134.6 mmHg, P = 0.089; DBP: from 78.2 to 82.5 mmHg, P < 0.001). Among participants aged 15­24 years, in 2014­2015 the prevalence of hypertension was 13.1% (95% confidence interval: 9.8­16.4). Conclusion: Our findings show that the prevalence of hypertension in Mozambique is among the highest in developing countries, both in adults and adolescents, portraying an ample margin for reduction of the morbidity and mortality burden because of high blood pressure.

Early diagnosis of preeclampsia using placental growth factor: An operational pilot study in Maputo, Mozambique

n well-resourced settings, reduced circulating maternal free placental growth factor (PlGF) aids in either predicting or confirming the diagnosis of preeclampsia, fetal growth restriction, stillbirth, preterm birth, and delivery within 14 days of testing when pre-eclampsia is suspected. This operational pilot implementation of maternal plasma PlGF in women with suspected preeclampsia was conducted in six antenatal clinics in Maputo, Mozambique (six control clinics for comparison). The primary outcome was transfer to higher levels of care, following the informative PlGF assay. Of antenatal visits, 133/31,993 (0.42%) and 20/33,841 (0.06%) resulted in pre-eclampsia-related transfers of care for women attending intervention and control clinics, respectively (p < .0001). The clinic-to-delivery for women with low PlGF (<100 pg/ml) interval was shorter, (vs normal PlGF (median 10 days [IQR 1-25] vs 36 [11-83], p < .0001)). Low PlGF was associated with younger maternal age, higher blood pressure, earlier delivery, more therapeutic interventions, preterm birth, lower birth weight, and perinatal loss. In addition, one-third of hypertensive women with PlGF < 50 pg/ml suffered a stillbirth. In urban Mozambican women with symptoms and/or signs suggestive of preeclampsia, low maternal plasma PlGF concentrations are associated with increased risks of adverse pregnancy outcomes, especially early delivery and stillbirth. Therefore, introducing PlGF into the clinical care of women with suspected preeclampsia was associated with increased transfers to higher levels of care; low PlGF (<100 pg/ml) was associated with increased maternal and perinatal risks. PlGF < 50 pg/ml is particularly associated with stillbirth in women with suspected preeclampsia.

Diagnostic Performance of Placental Growth Factor in Women With Suspected Preeclampsia Attending Antenatal Facilities in Maputo, Mozambique

In well-resourced settings, reduced circulating maternal-free placental growth factor (PlGF) aids in either predicting or confirming the diagnosis of preeclampsia, fetal growth restriction, stillbirth, preterm birth, and delivery within 14 days of testing when preeclampsia is suspected. This blinded, prospective cohort study of maternal plasma PlGF in women with suspected preeclampsia was conducted in antenatal clinics in Maputo, Mozambique. The primary outcome was the clinic-to-delivery interval. Other outcomes included: confirmed diagnosis of preeclampsia, transfer to higher care, mode of delivery, intrauterine fetal death, preterm birth, and low birth weight. Of 696 women, 95 (13.6%) and 601 (86.4%) women had either low (<100 pg/mL) or normal (≥100 pg/mL) plasma PlGF, respectively. The clinic-to-delivery interval was shorter in low PlGF, compared with normal PlGF, women (median 24 days [interquartile range, 10-49] versus 44 [24-81], P=0.0042). Also, low PlGF was associated with a confirmed diagnosis of preeclampsia, higher blood pressure, transfer for higher care, earlier gestational age delivery, delivery within 7 and 14 days, preterm birth, cesarean delivery, lower birth weight, and perinatal loss. In urban Mozambican women with symptoms or signs suggestive of preeclampsia, low maternal plasma PlGF concentrations are associated with increased risks of adverse pregnancy outcomes, whether the diagnosis of preeclampsia is confirmed. Therefore, PlGF should improve the provision of precision medicine to individual women and improve pregnancy outcomes for those with preeclampsia or related placenta-mediated complications.