Systematic review of observational studies of the impact of cardiovascular risk factors on preeclampsia in sub-saharan Africa.

BACKGROUND: Maternal mortality is a public health issue, particularly in low- and middle-income countries (LMIC). Sub-Saharan Africa (SSA) is the region most affected worldwide by maternal mortality, and preeclampsia is one of the main causes. We performed a systematic review of observational studies to identify the impact of cardiovascular risk factors on preeclampsia in SSA with a more representative sample. METHODS: Databases: PubMed and Google Scholar were searched to identify published studies. Studies were included if they reported results on the link between at least one cardiovascular risk factor and preeclampsia. Relevant studies quality was assessed with the Newcastle-Ottawa Scale (NOS). Odds ratios and relative risk (RR) were reported with their confidence intervals. RESULTS: Twelve articles (8 case-controls, 3 cohorts, 1 cross-sectional) were included in this review, with a total of 24,369 pregnant women. Cardiovascular risk factors such as chronic hypertension, overweight, obesity, diabetes and alcohol were significantly associated with a high risk of preeclampsia. Very few data were available concerning some risk factors. None of the articles reported tobacco consumption as a preeclampsia risk factor. There is a lack of data from French-speaking SSA countries. CONCLUSION: Cardiovascular risk factors increase the risk of preeclampsia. Our results suggest the need for prospective cohort studies to ascertain this association in order to reduce maternal mortality due to preeclampsia.

The prevalence, awareness, management and control of hypertension in men and women in Benin, West Africa: the TAHES study.

BACKGROUND: Due to epidemiological transitions, Sub-Saharan Africa is facing a growing burden of non-communicable diseases, including cardiovascular diseases (CVDs). Among their risk factors, hypertension is a major determinant of CVDs, but the prevalence and level of awareness and management of this condition are poorly studied in African populations. The aim of this study was to determine the prevalence of hypertension and identify its associated risk factors as well as the awareness and management of this condition in a community-dwelling cohort in Benin. METHODS: A cross-sectional door-to-door study was conducted in the population over the age of 25 years in Tanve, a rural setting in Benin. The questionnaire and anthropometric measurements of the World Health Organization STEPWISE survey were used. Blood pressure was measured using standard procedures. RESULTS: The sample included 1777 subjects (60.9% females, mean age was 42.5 ± 16.5 years). The prevalence of hypertension was 32.9%, similar in men (32.8%) and women (33.0%, p = 0.9342). Age and obesity were significantly associated with hypertension. Less than half (42%) of hypertensive people were aware about their condition and only 46.3% of them were treated. Awareness ratios differed between men and women (respectively 32.9% vs. 47.5%; p = 0.0039) and was not influenced by age, education, occupation, marital status or income. Female sex was the only factor associated with better controlled HTN, independent of socio-economic parameters. CONCLUSION: This large population-based study confirms the high prevalence, low awareness, and low control of hypertension in men and women in sub-Saharan Africa. Only half of the populations with hypertension are aware of their hypertension, indicating a high burden of undiagnosed and un-controlled high blood pressure in these populations.

[Impact of HIV status on the overall prevalence of chronic hepatitis B infection in Parakou, Benin]. / Prévalence de l'hépatite B chronique selon le statut sérologique VIH à Parakou au Bénin.

INTRODUCTION: The prevalence of hepatitis B is very variable across geographic areas and seems to be influenced by HIV infection. This study aims to evaluate the impact of serologic HIV status on the overall prevalence of hepatitis B in a Hospital in Parakou, Benin. METHODS: We conducted a cross-sectional study of adults aged 18 years old and over hospitalized in the Departmental University Hospital Center in Parakou between May 2011 and June 2012. The diagnosis of hepatitis B was made on the basis of rapid HBsAg tests while the diagnosis of HIV was made on the basis of rapid HIV tests using venous blood samples. Data were analyzed using EpiInfo software. Multivariate logistic regression model was implemented to investigate factors associated with hepatitis B. RESULTS: Out of 1516 subjects included, 744 were HIV seropositive. The average age was 31.3 + 11.1 years and 65.1% were women. The prevalence rate of hepatitis B in the whole sample was 13.9% [CI95:12.2%-15.7%]. This prevalence was higher in HIV seropositive subjects (16.9% vs 10.9%; p < 0.0006), however there was not a more significant difference in multivariate analysis, except for the group of subjects from Borgou/Alibori (p < 0.02). A consistent association was observed between age group 24-44 years (p < 0.03), male sex (p < 0.01), primary school education (p < 0.02) and a high prevalence of hepatitis B. CONCLUSION: The prevalence of hepatitis B was higher in HIV seropositive subjects. This was influenced by age, sex, education level and geographical origin.

Epidemiology of lower extremity artery disease in a rural setting in Benin, West Africa: The TAHES study.

BACKGROUND: Data on epidemiology of lower extremity artery disease (LEAD) in general population in Sub-Saharan Africa are sparse. This study aims to estimate the prevalence of LEAD among participants of Tanve Health Study (TAHES), a cohort about cardiovascular diseases (CVD) in a rural setting in Benin. METHODS: The cohort was launched since 2015 among adults aged over 25 years in Tanve, a village in Benin. Ankle-brachial index (ABI) was measured for the first time during the third annual visit of the cohort in 2017. Risk factors data were collected using the WHO STEPS adapted questionnaire in a systematic door-to-door survey. The LEAD was defined as ABI ≤ 0.90. RESULTS: We recorded ABI among 1003 out of 1407 TAHES' participants. A predominance of females (61.4%) was observed. The mean age was 44.4 ±â€¯15.7 years and 49.9% were under 40 years. Regarding CVD risk factors, prevalences were estimated for sedentary behavior (68.2%), harmful use of alcohol (3.9%), fruit and vegetable low intake (96.0%), tobacco smoking (5.2%), Overweight or obesity (Body mass index > 25) (27.7%), raised blood pressure (36.8%) and raised blood glucose (5.4%). Prevalence of LEAD was 5.5% (95%CI: 4.2%­7.1%) in the sample, 7.0% (95%CI: 5.1%­9.4%) in women and 3.1% (95%CI: 1.7%­5.5%) in men. Five individuals (0.5%; 95%CI: 0.2%­1.2%) had incompressible arteries (ABI ≥ 1.40), including four men. In multivariate analysis, LEAD was significantly associated with age ≥ 55 years (OR: 2.17; 95%CI: 1.20­3.92; p = 0.009) and female gender (OR: 2.27; 95%CI: 1.17­4.40; p = 0.014). CONCLUSION: Prevalence of LEAD is high in rural Benin and predominates among women and people over 55 years old.