Prevalence of hypercholesterolemia in Nigeria: a systematic review and meta-analysis.

OBJECTIVES: Elevated blood cholesterol (hypercholesterolemia) is a significant cause of cardiovascular disease. We aimed to estimate national and zonal prevalence of hypercholesterolemia in Nigeria to help guide targeted public health programs. STUDY DESIGN: This is a systematic review and synthesis of publicly available epidemiologic data on hypercholesterolemia in Nigeria. METHODS: We systematically searched MEDLINE, EMBASE, Global Health, and Africa Journals Online for studies on the prevalence of hypercholesterolemia in Nigeria published between 1990 and 2018. We used a random-effects meta-analysis (Freeman-Tukey double arcsine transformation) and meta-regression model to estimate the prevalence of hypercholesterolemia in Nigeria in 1995 and 2015. RESULTS: In total, 13 studies (n = 16,981) were retrieved. The pooled crude prevalence of hypercholesterolemia in Nigeria was 38% (95% confidence interval: 26-51), with prevalence in women slightly higher (42%, 23-63) compared with men (38%, 20-58). The prevalence was highest in the South-south (53%, 38-68) and lowest in the South-west (3%, 2-4) and North-east (4%, 2-7). Urban dwellers had a significantly higher rate (52%, 24-79) compared with rural dwellers (10%, 6-15). We estimated over 8.2 million persons (age-adjusted prevalence 16.5%) aged 20 years or more had hypercholesterolemia in Nigeria in 1995, increasing to 21.9 million persons (age-adjusted prevalence 25.9%) in 2015. CONCLUSIONS: Our findings suggest a high prevalence of hypercholesterolemia in Nigeria. Urbanization, lifestyles, diets, and culture appear to be driving an increasing prevalence, especially among women. Population-wide awareness and education on reducing elevated cholesterol levels and associated risks should be prioritized.

Scaling up antiretroviral therapy in Africa: learning from tuberculosis control programmes--the case of Malawi.

The rapid and massive scale-up of antiretroviral drug therapy (ART) so needed in sub-Saharan Africa will not be possible using a 'medicalised' model. A more simple approach is required. DOTS has been used now for many years to provide successful anti-tuberculosis treatment to millions of patients in poor countries of the world, and many of the established concepts can be used for the delivery of ART. Malawi, a small and impoverished country in sub-Saharan Africa, is embarking on a national scale-up of ART. In this review we describe how we have adopted several of the principles of DOTS for delivering ART in Malawi: case finding and registration, treatment, monitoring, drug procurement, staffing and the issue of free drugs. We also discuss ART for HIV-infected TB patients. We hope that by using the DOTS approach we will be able to deliver ART to large numbers of HIV-infected patients under controlled conditions, and minimise the risk of developing drug resistance.

Scaling up HIV/AIDS and joint HIV-TB services in Malawi.

Two country-wide surveys were undertaken to assess progress in scaling up human immunodeficiency virus/ acquired immune-deficiency syndrome (HIV/AIDS) and HIV-tuberculosis (TB) services in the public health sector in Malawi between 2002 and 2003. In 2003, 118 sites were performing counselling and HIV testing compared with 70 in 2002. There were 215 269 HIV tests carried out in 2003 compared with 149 540 in 2002, the largest increases being in pregnant women (from 5059 to 26791), patients with TB (from 2130 to 3983) and patients/clients attending health facilities (from 35 407 to 79 584). In 2003, 3703 patients with AIDS were started on antiretroviral therapy compared with 1220 patients in 2002.