Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana

Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients.Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF.Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality.Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality.Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub-Saharan Africa, and call for more studies to be done in this region

Presentation and mortality of patients hospitalised with acute heart failure in Botswana

Introduction: Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana.Methods: Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed.Results: The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay.Conclusions: AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV

Anthropometric growth in school children aged 9-15 years

Anthropometric measurements are presented for Dar es Salaam school children aged between 9-15 years. Girls are heavier than boys (P less than 0.001); and attain almost a plateau in standing height by 15 years age. In girls; sitting to standing height percent increase with age by about 0.2 percent years as compared to a 0.67 percent year decline in boys suggesting that; the increase in standing height with age in girls results from more trunk than leg height growth as compared to more leg than trunk height growth in boys. Boys have wider chest (P less than 0.001) than girls and become taller than girls after 14 years of age. Despite having similar onset of accelerated and trends of anthropometric growth about 60 percent of the subjects in this study have smaller standing height and weight than values reported in Caucasians of comparable age. It is recommended that further work is required to include children between 0-8 years of age also from rural areas so that comprehensive reference values could be constructed

Ventilatory functions in healthy adult male textile employees

Spirometric measurements were performed in 718 health; asymptomatic and life long nonsmoking male Tanzanians aged between 20-60 years using a dry-wedge spirometer (Vitalograph). The study was undertaken to determine normal values for forced vital capacity (FVC); one second forced expired volume (FEV1); FEV1 as percent of FVC (FEV1 percent FVC); and construct prediction equations from these data in a large population of health adult male textile employees in Dar es Salaam. Measurement were performed in accordance with European Community for Coal and steel (ECCS) recommendations. Regression analyses were used to derive prediction equation for FVC; FEV1; and FEV1 percent FVC in this population. FVC remained relatively constant through 30 years before decreasing in subjects greater than 30 years of age. [abstract terminated]