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1.
Artigo em Inglês | MEDLINE | ID: mdl-34508671

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the prevalence is estimated to be 13·5% for the general population. This is likely to be an underestimate considering the increasing burden of non-communicable diseases, particularly the rising prevalence of obesity and type 2 diabetes, driven by the overlapping challenges of food insecurity, nutritional transition, and associated increased consumption of calorie-dense foods. Establishing the true prevalence of NAFLD, raising public awareness around the risk factors behind the increase in NAFLD, and proactively addressing all components of metabolic syndrome will be important to combat this silent epidemic, which will have long-term health-care costs and economic consequences for the region.

3.
J Viral Hepat ; 28(7): 994-1002, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33797190

RESUMO

Very few low-income countries have developed national plans to achieve the viral hepatitis elimination targets set in the World Health Organization (WHO) strategy. We reviewed the policy environment, strategies and challenges on the fight against viral hepatitis in Zimbabwe. The review focussed on the Ministry of Health and Child Care (MoHCC) policy documents, strategic plans and reports. We performed key informant interviews to enhance evidence generated from the document review. Twelve documents were reviewed and interviews with 10 key informants were completed. The MoHCC established a technical working group to work towards elimination of viral hepatitis. The technical working group drafted a strategic plan for elimination of viral hepatitis; however, it is still awaiting implementation. Key strategies that are working well include screening of donated blood for transfusion, safe injection practices and hepatitis B virus (HBV) three-dose vaccination. Current challenges in the drive towards elimination of viral hepatitis include poor to non-existent surveillance systems, lack of epidemiological data, absence of the HBV vaccine birth dose and lack of systematic screening and treatment services for viral hepatitis. In conclusion, despite political will demonstrated towards achieving viral hepatitis elimination, substantial investment and work are required to implement the strategic plan and realize significant success.


Assuntos
Hepatite B , Hepatite Viral Humana , Política de Saúde , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Vacinas contra Hepatite B , Hepatite Viral Humana/epidemiologia , Hepatite Viral Humana/prevenção & controle , Humanos , Organização Mundial da Saúde , Zimbábue/epidemiologia
4.
BMJ Open ; 10(12): e039456, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33371021

RESUMO

INTRODUCTION: The epidemiology of inflammatory bowel disease (IBD) in sub-Saharan Africa is poorly documented. We have started a registry to determine the burden, phenotype, risk factors, disease course and outcomes of IBD in Zimbabwe. METHODS AND ANALYSIS: A prospective observational registry with a nested case-control study has been established at a tertiary hospital in Harare, Zimbabwe. The registry is recruiting confirmed IBD cases from the hospital, and other facilities throughout Zimbabwe. Demographic and clinical data are obtained at baseline, 6 months and annually. Two age and sex-matched non-IBD controls per case are recruited-a sibling or second-degree relative, and a randomly selected individual from the same neighbourhood. Cases and controls are interviewed for potential risk factors of IBD, and dietary intake using a food frequency questionnaire. Stool is collected for 16S rRNA-based microbiota profiling, and along with germline DNA from peripheral blood, is being biobanked. The estimated sample size is 86 cases and 172 controls, and the overall registry is anticipated to run for at least 5 years. Descriptive statistics will be used to describe the demographic and phenotypic characteristics of IBD, and incidence and prevalence will be estimated for Harare. Risk factors for IBD will be analysed using conditional logistic regression. For microbial analysis, alpha diversity and beta diversity will be compared between cases and controls, and between IBD phenotypes. Mann-Whitney U tests for alpha diversity and Adonis (Permutational Multivariate Analysis of Variance) for beta diversity will be computed. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Parirenyatwa Hospital's and University of Zimbabwe's research ethics committee and the Medical Research Council of Zimbabwe. Findings will be discussed with patients, and the Zimbabwean Ministry of Health. Results will be presented at scientific meetings, published in peer reviewed journals, and on social media. TRIAL REGISTRATION NUMBER: NCT04178408.


Assuntos
Doenças Inflamatórias Intestinais , África ao Sul do Saara/epidemiologia , Estudos de Casos e Controles , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Estudos Observacionais como Assunto , RNA Ribossômico 16S , Sistema de Registros , Zimbábue
5.
Clin Infect Dis ; 71(16): 2180-2183, 2020 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-32392333

RESUMO

The trajectory and impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in sub-Saharan Africa are unclear, but they are seemingly varied between different countries, with most reporting low numbers. We use the situation in Zimbabwe to build an argument that the epidemic is likely to be attenuated in some countries with similar socioeconomic and cultural structures. However, even an attenuated epidemic may overwhelm weak health systems, emphasizing the importance of prevention. These prevention strategies should be tailored to the unique social and cultural networks of individual countries, which may facilitate the spread of SARS-CoV-2. It is also equally important to maintain services for the major infectious diseases in the region, such as tuberculosis and malaria. A breakdown of treatment and prevention services for these conditions may even overshadow the projected morbidity and mortality from coronavirus disease 2019 (COVID-19).


Assuntos
COVID-19/epidemiologia , SARS-CoV-2/patogenicidade , África/epidemiologia , COVID-19/virologia , Humanos , Zimbábue/epidemiologia
6.
PLoS One ; 14(10): e0224023, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31647837

RESUMO

BACKGROUND: Approximately 25% of colorectal cancer patients in sub-Saharan Africa are younger than 40 years, and hereditary factors may contribute. We investigated the frequency and patterns of inherited colorectal cancer among black Zimbabweans. METHODS: A population-based cross-sectional study of ninety individuals with a new diagnosis of colorectal cancer was carried out in Harare, Zimbabwe between November 2012 and December 2015. Phenotypic data was obtained using interviewer administered questionnaires, and reviewing clinical and pathology data. Cases were screened for mismatch repair deficiency by immunohistochemistry and/or microsatellite instability testing, and for MLH1, MSH2 and EPCAM deletions using multiplex ligation-dependent probe amplification. Next generation sequencing using a 16-gene panel was performed for cases with phenotypic features consistent with familial colorectal cancer. Variants were assessed for pathogenicity using the mean allele frequency, phenotypic features and searching online databases. RESULTS: Three Lynch syndrome cases were identified: MSH2 c.2634G>A pathogenic mutation, c.(1896+1_1897-1)_(*193_?)del , and one fulfilling the Amsterdam criteria, with MLH1 and PMS2 deficiency, but no identifiable pathogenic mutation. Two other cases had a strong family history of cancers, but the exact syndrome was not identified. The prevalence of Lynch syndrome was 3·3% (95% CI 0·7-9·4), and that of familial colorectal cancer was 5·6% (95% CI, 1·8-12·5). CONCLUSIONS: Identifying cases of inherited colorectal cancer in sub-Saharan Africa is feasible, and our findings can inform screening guidelines appropriate to this setting.


Assuntos
Grupo com Ancestrais do Continente Africano/genética , Neoplasias Colorretais/genética , Molécula de Adesão da Célula Epitelial/genética , Predisposição Genética para Doença , Mutação em Linhagem Germinativa , Proteína 1 Homóloga a MutL/genética , Proteína 2 Homóloga a MutS/genética , Adulto , Idade de Início , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Instabilidade de Microssatélites , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Zimbábue/epidemiologia
7.
Eur J Cancer Prev ; 28(3): 145-150, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29649072

RESUMO

The interplay between hereditary and environmental factors in the causation of colorectal cancer in sub-Saharan Africa is poorly understood. We carried out a community based case-control study to identify the risk factors associated with colorectal cancer in Zimbabwe. We recruited 101 cases of colorectal cancer and 202 controls, matched for age, sex and domicile. Potential risk factors including family history, socioeconomic status, urbanization, diabetes mellitus and previous schistosomiasis were evaluated. Conditional logistic regression was used to estimate the odds ratios associated with the different factors. Cases were more likely to have a tertiary education (32.7 vs. 13.4%, P<0.001) and a higher income (18.8 vs. 6.9%, P=0.002). After multivariate analysis, diabetes mellitus [odds ratio (OR): 5.3; 95% confidence interval (CI): 1.4-19.9; P=0.012], previous urban domicile (OR: 2.8; 95% CI: 1.0-7.8; P=0.042), previous schistosomiasis (OR: 2.4; 95% CI: 1.4-4.2; P=0.001) and cancer in a first-degree relative (OR: 2.4; 95% CI: 1.2-4.8; P=0.018) were associated independently with colorectal cancer. Our findings suggest that family history, diabetes mellitus, previous schistosomiasis and approximation to a western lifestyle are the predominant associations with colorectal cancer in Africans. This offers opportunities for targeted prevention and hypothesis-driven research into the aetiology of colorectal cancer in this population.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Zimbábue/epidemiologia
8.
Cancer Epidemiol ; 57: 33-38, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30286315

RESUMO

BACKGROUND: The rising incidence of colorectal cancer in sub-Saharan Africa may be partly caused by changing dietary patterns. We sought to establish the association between dietary patterns and colorectal cancer in Zimbabwe. METHODS: One hundred colorectal cancer cases and 200 community-based controls were recruited. Data were collected using a food frequency questionnaire, and dietary patterns derived by principal component analysis. Generalised linear and logistic regression models were used to assess the associations between dietary patterns, participant characteristics and colorectal cancer. RESULTS: Three main dietary patterns were identified: traditional African, urbanised and processed food. The traditional African diet appeared protective against colorectal cancer (Odds Ratio (OR) 0.35; 95% Confidence Interval (CI), 0.21 - 0.58), which had no association with the urban (OR 0.68; 95% CI, 0.43-1.08), or processed food (OR 0.91; 0.58-1.41) patterns. The traditional African diet was associated with rural domicile, (OR 1.26; 95% CI, 1.00-1.59), and a low income (OR1.48; 95% CI, 1.06-2.08). The urbanised diet was associated with urban domicile (OR 1.70; 95% CI, 1.38-2.10), secondary (OR 1.30; 95% CI, 1.07-1.59) or tertiary education (OR 1.48; 95% CI, 1.11-1.97), and monthly incomes of $201-500 (OR 1.30; 95% CI, 1.05-1.62), and the processed food pattern with tertiary education (OR 1.42; 95% CI, 1.05-1.92), and income >$1000/month (OR 1.48; 95% CI, 1.02-2.15). CONCLUSION: A shift away from protective, traditional African dietary patterns may partly explain the rising incidence of colorectal cancer in sub-Saharan Africa.


Assuntos
Neoplasias Colorretais/epidemiologia , Dieta , Adulto , Idoso , Estudos de Casos e Controles , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , População Rural , Inquéritos e Questionários , Zimbábue/epidemiologia
9.
Lancet Gastroenterol Hepatol ; 2(5): 377-383, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28397702

RESUMO

The perception that colorectal cancer is rare in sub-Saharan Africa is widely held; however, it is unclear whether this is due to poor epidemiological data or to lower disease rates. The quality of epidemiological data has somewhat improved, and there is an ongoing transition to western dietary and lifestyle practices associated with colorectal cancer. The impact of these changes on the incidence of colorectal cancer is not as evident as it is with other non-communicable diseases such as diabetes. In this Viewpoint, we discuss the epidemiology of colorectal cancer in sub-Saharan Africa. Colorectal cancer in this region frequently occurs at an early age, often with distinctive histological characteristics. We detail the crucial need for hypothesis-driven research on the risk factors for colorectal cancer in this population and identify key research gaps. Should colorectal cancer occur more frequently than assumed, then commensurate allocation of resources will be needed for diagnosis and treatment.


Assuntos
Neoplasias Colorretais/epidemiologia , Adulto , África ao Sul do Saara/epidemiologia , Idade de Início , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/genética , Dieta , Feminino , Humanos , Incidência , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco
10.
Cancer Epidemiol ; 44: 96-100, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27541963

RESUMO

BACKGROUND: Data on colorectal cancer (CRC) in sub-Saharan Africa is mainly based on hospital series which suggest low incidence and frequent early onset cancers. This study characterises colorectal cancer in a population-based cancer registry in Zimbabwe. METHODS: Cases of CRC recorded by the Zimbabwe National Cancer Registry between 2003 and 2012 were analysed. Demographic and pathological characteristics were compared according to ethnicity and age. Trends in age standardised incidence rates (ASR) were determined. RESULTS: There were 886 and 216 cases of CRC among black Africans and Caucasians respectively, and 26% of the black Africans were younger than 40 years. Signet ring cell carcinomas were more common among black Africans compared to Caucasians (4% vs 1%, p=0.027). ASR increased by 1.9%/year and 3.9%/year among black African males and females respectively. CONCLUSION: CRC incidence is rising among black Africans and has unique demographic and pathological characteristics.


Assuntos
Adenocarcinoma Mucinoso/epidemiologia , Adenocarcinoma/epidemiologia , Carcinoma de Células em Anel de Sinete/epidemiologia , Neoplasias Colorretais/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adenocarcinoma/patologia , Adenocarcinoma Mucinoso/patologia , Adulto , Idoso , Carcinoma de Células em Anel de Sinete/patologia , Neoplasias Colorretais/patologia , Grupos Étnicos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Zimbábue/epidemiologia
11.
Cardiovasc J Afr ; 26(3): e7-e10, 2015 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-26592992

RESUMO

The commonest cause of a large fibrinous pericardial effusion in sub-Saharan Africa is tuberculosis. There are, however, limited resources available for making a definitive diagnosis of tuberculous pericarditis. The diagnosis is largely based on clinical criteria. There is a risk of misdiagnosing less-common causes of large fibrinous pericardial effusions. We present a patient who had a pericardial angiosarcoma that was initially thought to be a tuberculous pericardial effusion, and discuss the challenges in making a definitive diagnosis of tuberculosis.


Assuntos
Erros de Diagnóstico , Neoplasias Cardíacas/diagnóstico , Hemangiossarcoma/diagnóstico , Derrame Pericárdico/etiologia , Tuberculose/diagnóstico , Antituberculosos/uso terapêutico , Biópsia , Procedimentos Cirúrgicos Cardíacos , Quimioterapia Adjuvante , Evolução Fatal , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/terapia , Hemangiossarcoma/complicações , Hemangiossarcoma/terapia , Humanos , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapia , Pericardiocentese , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Procedimentos Desnecessários , Adulto Jovem
12.
World J Gastroenterol ; 21(8): 2374-80, 2015 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-25741144

RESUMO

AIM: To compare differences in the frequency of colorectal cancer at colonoscopy in Zimbabwe according to ethnicity. METHODS: All lower gastrointestinal endoscopic procedures performed between January 2006 and December 2011 at a gastroenterology clinic in Harare, Zimbabwe were reviewed. The demographic characteristics, clinical indications, differences in bowel preparation and the endoscopic and histological diagnoses were compared between different ethnic groups with emphasis on colorectal cancer. The clinical and demographic characteristics and the endoscopic findings were compared using the student t-test and the χ2 test, while the clinical indications associated with a diagnosis of colorectal cancer were determined by logistic regression. RESULTS: All colonoscopies and sigmoidoscopies performed in 1236 Caucasians, 460 black Africans and 109 Asians were analysed. Colorectal cancer was diagnosed more frequently in the black African patients compared to Caucasians or Asians (10% vs 3%, 10% vs 2%, P<0.001). However, polyps were less common among black Africans (5%) compared to both Caucasians (8%) and Asians (9%) (P=0.03). Among patients with colorectal cancer, black Africans tended to be younger than Caucasians, who were over-represented in the oldest age category; 32 % vs 2% were less than 50 years and 41% vs 78% were older than 60 years (P<0.001). Anaemia and weight loss were associated with colorectal cancer in both black African [odds ratio (OR): 2.73 (95%CI: 1.33-5.61) and 3.09 (1.35-7.07)] and Caucasian patients [OR: 6.65 (95%CI: 2.93-15.09) and 3.47 (1.52-7.94)]. CONCLUSION: The likelihood of diagnosing colorectal cancer in patients referred for colonoscopy in Zimbabwe is at least as likely among black Africans as it is among Caucasians.


Assuntos
Pólipos Adenomatosos/patologia , Pólipos do Colo/patologia , Colonoscopia , Neoplasias Colorretais/patologia , Pólipos Adenomatosos/etnologia , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Anemia/etnologia , Grupo com Ancestrais do Continente Asiático , Distribuição de Qui-Quadrado , Pólipos do Colo/etnologia , Neoplasias Colorretais/etnologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Sigmoidoscopia , Perda de Peso/etnologia , Zimbábue/epidemiologia
13.
Trop Med Int Health ; 16(9): 1120-30, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21668592

RESUMO

Southern Africa continues to shoulder a disproportionate burden of the HIV epidemic with the number of new infections outstripping treatment initiation two- to threefold. Current prevention strategies have had a limited impact on the trajectory of the epidemic so far. The history of HIV prevention research is dominated by failed approaches, but recent developments have provided reason for hope. These include the successful male circumcision outcomes in trials in South Africa, Kenya and Uganda, the recent protective outcome of a tenofovir vaginal gel trial in South Africa and the proof that pre-exposure prophylaxis with oral combination tenofovir/emtricitabine can work in men. The latter positive outcome has however been shattered by the early closure of FEM-PrEP for futility. The challenge now is on how to best integrate emerging prevention methods with established strategies, recognising that some of the older methods have never been scaled up to saturation level.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Infecções por HIV/terapia , Medicina Preventiva/métodos , Comportamento de Redução do Risco , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Adenina/análogos & derivados , Adenina/uso terapêutico , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Circuncisão Masculina , Preservativos Femininos/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Soropositividade para HIV , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Organofosfonatos/uso terapêutico , Tenofovir , Adulto Jovem
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