Hypertension-the Major Cause of Morbidity, Hospitalisation and Mortality among Non-communicable Diseases in the Gambia.

Aim: This study aimed at investigating the major cause of morbidity, hospitalisation and mortality among Non-communicable Diseases (NCDs) in The Gambia, in an effort to raise awareness on the alarming trend and thus stimulating appropriate responses from stakeholders. Method: Descriptive and inferential statistics were used to analyse a nation-wide routine hospital-based data on NCDs in The Gambia. Data were also presented in tables showing the trend of morbidity (in and out-patient case), hospitalisation and mortality between 2008 and 2011. Result: Hypertension as a risk factor for cardiovascular diseases constitutes more than half (55%) of all hospital admissions due to NCDs while cardiovascular diseases as a whole constitute well over 60% of all hospital admissions from NCDs. Of all NCDs studied, morbidity due to hypertension constitutes 80%, nearly responsible for all morbidities due to cardiovascular diseases for the years considered. Seventy percent (70%) of all deaths due to NCDs were caused by cardiovascular diseases, and hypertension was an important factor for NCDs related mortality (47.9% in 2008 to 55.8% in 2011;p-value=0.13). There were increments in morbidity and mortality due to hypertension and cardiovascular diseases between 2008 and 2011. However, there was reduction in hospitalisation due to cardiovascular diseases, but not the case with hypertension (incremental change). The differences in morbidity and hospitalisation were statistically significant for cardiovascular diseases (p<0.0001 and p=0.034 respectively) while only increment in morbidity due to hypertension was statistically significant (p<0.0001). Conclusion: This study shows that hypertension as a risk factor for cardiovascular disease is the greatest cause of morbidity, hospitalisation and mortality among NCDs in The Gambia. Hence, a holistic approach tailored towards preventing the acquisition/onset of the modifiable risk factors (of hypertension and CVD) should be instituted as well as programmes capable of preventing target organ damage among the population already affected.

Population-Based Interventions to Reduce the Public Health Burden Related with Hepatitis B Virus Infection in The Gambia, West Africa

In The Gambia, West Africa, the prevalence of chronic hepatitis B virus (HBV) infection in adults exceeds eight percent and hepatocellular carcinoma (HCC) has been the most frequent type of malignancy. Two population-based intervention studies to control HBV infection, namely, GHIS (Gambia Hepatitis Intervention Study) and PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa), are discussed. The GHIS started in 1986 as a nation-wide trial of the HBV vaccine to evaluate the effectiveness of infant HBV vaccination in preventing HCC in adulthood. The vaccine was progressively introduced into the Expanded Program of Immunization (EPI) of The Gambia over four years in a phased manner, called the “stepped-wedge” design. This was because instantaneous universal vaccination in the country was impossible for logistic and financial reasons. However, this design also allowed the study to have an unvaccinated control group which consisted of the newborns of the areas where HBV vaccine has not yet been incorporated in the EPI. To assess the outcome, a national cancer registry was founded and all HCC patients in this birth cohort are linked with the vaccine trial database. The study is still ongoing to answer whether the HBV vaccine in infancy prevent HCC in adulthood in The Gambia. Although the universal HBV vaccination since 1990 has been successful in reducing the prevalence of chronic HBV infection in young Gambians, the number of HCC cases may not decline over the next decades as people infected prior to the immunization program are likely to continue to develop the diseases. To reduce the HCC incidence through community-based screening of HBV infection and provision of antiviral therapy, the PROLIFICA project started in 2011. Study hypothesis and design of these two studies, GHIS and PROLIFICA, are further discussed.

Population-based interventions to reduce the public health burden related with hepatitis B virus infection in The Gambia, West Africa

In The Gambia, West Africa, the prevalence of chronic hepatitis B virus (HBV) infection in adults exceeds eight percent and hepatocellular carcinoma (HCC) has been the most frequent type of malignancy. Two population-based intervention studies to control HBV infection, namely, GHIS (Gambia Hepatitis Intervention Study) and PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa), are discussed.The GHIS started in 1986 as a nation-wide trial of the HBV vaccine to evaluate the effectiveness of infant HBV vaccination in preventing HCC in adulthood. The vaccine was progressively introduced into the Expanded Program of Immunization (EPI) of The Gambia over four years in a phased manner, called the “stepped-wedge” design. This was because instantaneous universal vaccination in the country was impossible for logistic and financial reasons. However, this design also allowed the study to have an unvaccinated control group which consisted of the newborns of the areas where HBV vaccine has not yet been incorporated in the EPI. To assess the outcome, a national cancer registry was founded and all HCC patients in this birth cohort are linked with the vaccine trial database. The study is still ongoing to answer whether the HBV vaccine in infancy prevent HCC in adulthood in The Gambia. Although the universal HBV vaccination since 1990 has been successful in reducing the prevalence of chronic HBV infection in young Gambians, the number of HCC cases may not decline over the next decades as people infected prior to the immunization program are likely to continue to develop the diseases. To reduce the HCC incidence through community-based screening of HBV infection and provision of antiviral therapy, the PROLIFICA project started in 2011. Study hypothesis and design of these two studies, GHIS and PROLIFICA, are further discussed.

Determinants of Appropriate Child Health and Nutrition Practices among Women in Rural Gambia.

Health education and awareness involves providing knowledge about causes of illness and choices to promote a change in individual behaviour and, thus, improves survival of individuals. Studies have, however, shown that improved knowledge and awareness is not always translated into appropriate actions. This study aimed at exploring the factors determining mothers’ choices of appropriate child health and nutrition practices in the Gambia. Eight focus-group discussions (FGDs) were held with 63 women whose children had been seen at the Keneba MRC Clinic within the 12 months preceding the study. The FGDs were analyzed using a thematic framework. Gender inequality, presence or absence of support networks, alternative explanatory models of malnutrition, and poverty were identified as the main factors that would determine the ability of a mother to practise what she knows about child health and nutrition. The findings highlight the need to consider the broader social, cultural and economic factors, including the value of involving men in childcare, when designing nutritional interventions.