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Epidemiology, Clinical Presentations and In-Hospital Mortality of Venous Thromboembolism at the Douala General Hospital: A Cross-Sectional Study in Cameroon, Sub-Saharan Africa  [PDF]
Félicité Kamdem, Bertrand Hugo Mbatchou Ngahane, Ba Hamadou, Agborbessong Mongyui, Marie Solange Doualla, Ahmadou Musa Jingi, Anastase Dzudie, Yves Monkam, Henri Ngote, Sidick Mouliom, Caroline Kenmegne, Jaff Kweban Fenkeu, Romuald Hentchoya, Albert Kana, Aminata Coulibaly, Henry Luma
World Journal of Cardiovascular Diseases (WJCD) , 2018, DOI: 10.4236/wjcd.2018.82012
Abstract: Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide. It is also the most common complication in hospitalized patients. Aims:?To?study the in-hospital prevalence of VTE, describe the socio-demographic characteristics of patients, determine the frequency of risk factors, describe the clinical presentations, and determine the short term outcome of VTE in hospitalized patients in a low-income tertiary hospital setting.Methods: We carried out a cross-sectional descriptive retrospective study over a period of 6 years and 4 months (January 2008 to April 2014) in the Douala General HospitalCameroon. Patients were cases of confirmed venous thromboembolic disease (VTE).Results: A total of 78 case files were retained for this study, giving an in-hospital prevalence of 4.4 per 1000 admissions. There were 42 (53.8%) males and 36 (46.1%) females. Their ages ranged from 18 to 89 years (median: 53 years, [IQR: 40?-?61]).There were 37 (47.4%) cases of Deep Vein Thrombosis (DVT), 31 (39.7%) cases of Pulmonary Embolism (PE), and 10 (12.8%) cases of PE associated with DVT (12.8%). The main risk factors were obesity (44.9%), hypertension (37.2%), immobility (20.5%), and long-haul travel (17.9%). The most frequent clinical presentations in PE were dyspnea (80.5%) and chest pain (65.9%). There were 8 (10%) in-hospital deaths. Conclusion: About twelve cases of VTE are seen yearly at the DGH, with an in-hospital mortality of ten percent. Obesity and hypertension were the main risk factors, with dyspnea and chest pain being the main clinical manifestations in PE, and lower limb swelling the main symptom in DVT.
Pulmonary embolism: epidemiology and diagnosis. Part 1
Thiago Domingos Corrêa,Alexandre Biasi Cavalcanti,Antonio Cláudio do Amaral Baruzzi
Einstein (S?o Paulo) , 2007,
Abstract: Pulmonary embolism is a potentially lethal disorder, consequent tothrombi formed in the deep venous system that, once detached,cross the right chambers of the heart, thus obstructing the pulmonaryartery or one of its branches. Mortality rate associated to untreatedembolism is approximately 30%. A quick diagnosis is crucial, sincetreatment reduces mortality and morbidity, and improves the qualityof life for reducing the likelihood of thromboembolic pulmonaryhypertension and post-thrombotic syndrome. The objective of thisarticle is to present a literature review on this condition, divided intotwo parts. On the first part we approach the practical aspects of itsepidemiology, pathophysiology, identification of risk factors, clinical,laboratorial and imaging diagnostic methods. On the second, themain aspects of its medical and surgical treatments are addressed.
Molecular typing of the pneumococcus and its application in epidemiology in sub-Saharan Africa  [PDF]
Eric S. Donkor
Frontiers in Cellular and Infection Microbiology , 2013, DOI: 10.3389/fcimb.2013.00012
Abstract: Molecular typing of the pneumococcus has played a crucial role in understanding the epidemiology of the organism. However, most of what is known about molecular epidemiology of the pneumococcus pertains to the developed world. The brunt of pneumococcal infections is borne by sub-Saharan African countries, which makes epidemiological monitoring of the pneumococcus essential in this region of the world. This review paper focuses on molecular typing of the pneumococcus and what is known about epidemiology of the organism in sub-Saharan Africa based on the various typing methods. Several molecular typing methods are available for typing the pneumococcus and the major ones include multilocus sequence typing (MLST), multilocus enzyme electrophoresis (MLEE), serotyping and DNA fingerprinting methods such as pulsed field gel electrophoresis (PFGE) and amplified fragment length polymorphism (AFLP). Currently, MLST is the most suitable method for typing the pneumococcus. The pneumococcal population structure in sub-Saharan Africa appears to be quite different from that of the developed world, and pneumococcal serotype 1 related to the ST 618 clone and clones of the ST 217 clonal complex are responsible for outbreaks in sub-Saharan Africa.
Quantitative urban classification for malaria epidemiology in sub-Saharan Africa
Jose G Siri, Kim A Lindblade, Daniel H Rosen, Bernard Onyango, John Vulule, Laurence Slutsker, Mark L Wilson
Malaria Journal , 2008, DOI: 10.1186/1475-2875-7-34
Abstract: Seven variables with a known or expected relationship with malaria in the context of urbanization were identified and measured at the census enumeration area (EA) level, using three sources: a) the results of a citywide knowledge, attitudes and practices (KAP) survey; b) a high-resolution multispectral satellite image; and c) national census data. Principal components analysis (PCA) was used to identify three factors explaining higher proportions of the combined variance than the original variables. A k-means clustering algorithm was applied to the EA-level factor scores to assign EAs to one of three categories: "urban," "peri-urban," or "semi-rural." The results were compared with classifications derived from two other approaches: a) administrative designation of urban/rural by the census or b) population density thresholds.Urban zones resulting from the clustering algorithm were more geographically coherent than those delineated by population density. Clustering distributed population more evenly among zones than either of the other methods and more accurately predicted variation in other variables related to urbanization, but not used for classification.Effective urban malaria epidemiology and control would benefit from quantitative methods to identify and characterize urban areas. Cluster analysis techniques were used to classify Kisumu, Kenya, into levels of urbanization in a repeatable and unbiased manner, an approach that should permit more relevant comparisons among and within urban areas. To the extent that these divisions predict meaningful intra-urban differences in malaria epidemiology, they should inform targeted urban malaria interventions in cities across SSA.The increasing urbanization of sub-Saharan Africa (SSA) may profoundly alter the epidemiology of malaria on the continent. The proportion of Africans living in cities is rapidly rising, and projected to reach 50% by 2030 [1]. Nonetheless, some debate exists over the relative importance of urban m
Acute pulmonary embolism in the era of multi-detector CT: a reality in sub-Saharan Africa  [cached]
Tambe Joshua,Moifo Boniface,Fongang Emmanuel,Guegang Emilienne
BMC Medical Imaging , 2012, DOI: 10.1186/1471-2342-12-31
Abstract: Background The advantages of multi-detector computed tomography (MDCT) have made it the imaging modality of choice for some patients with suspected cardiothoracic disease, of which pulmonary embolism (PE) is an exponent. The aim of this study was to assess the incidence of PE in patients with clinical suspicion of acute PE using MDCT in a sub-Saharan setting, and to describe the demographic characteristics of these patients. Methods Consecutive records of patients who underwent MDCT pulmonary angiography for suspected acute PE over a two-year period at the Radiology Department of a university-affiliated hospital were systematically reviewed. All MDCT pulmonary angiograms were performed with a 16-detector computed tomography (CT) scanner using real-time bolus tracking technique. Authorization for the study was obtained from the institutional authorities. Results Forty-one MDCT pulmonary angiograms were reviewed of which 37 were retained. Of the 4 excluded studies, 3 were repeat angiograms and 1 study was not technically adequate. Twelve of 37 patients (32.4%) had CT angiograms that were positive for PE, of which 7 were males. The mean age of these patients was 47.6±10.5 years (age range from 33 to 65 years). Twenty five patients out of 37 (67.6%) had CT angiograms that were negative for PE. Eleven PE-positive patients (91.7%) had at least 1 identifiable thromboembolic risk factor whilst 5 PE-negative patients (20%) also had at least a thromboembolic risk factor. The relative risk of the occurrence of PE in patients with at least a thromboembolic risk factor was estimated at 14.4. Conclusion Acute PE is a reality in sub-Saharan Africa, with an increased likelihood of MDCT evidence in patients with clinical suspicion of PE who have at least a thromboembolic risk factor. The increasing availability of MDCT will help provide more information on the occurrence of PE in these settings.
Rewriting the narrative of the epidemiology of HIV in sub-Saharan Africa
S Baral, N Phaswana-Mafuya
SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) , 2012,
Abstract: The fight against HIV remains complicated with contracting donor resources and high burden of HIV among reproductive age adults still often limiting independent economic development. In the widespread HIV epidemics of sub-Saharan Africa (SSA), it is proposed that key populations with specific HIV acquisition and transmission risk factors, such as men who have sex with men (MSM), female sex workers (FSW), and people who use drugs (PUD), are less relevant because HIV transmission is sustained in the general population with average HIV acquisition and transmission risks. However, the understanding that key populations are less relevant in the epidemics of Africa is based on the surveillance system from which these populations are mostly excluded. Outside of SSA, the epidemics of HIV are generally concentrated in the same populations that are excluded from the primary HIV surveillance systems in SSA. The manuscripts included in this special issue present convincing data that FSW, MSM, and PUD carry disproportionate burdens of HIV wherever studied in SSA, are underrepresented in HIV programs and research, and require specific HIV prevention services. These manuscripts collectively suggest that the only effective path forward is one that transcends denial and stigma and focuses on systematically collecting data on all populations at risk for HIV. In addition, there is a need to move to a third generation of HIV surveillance as the current one inadvertently devalues HIV surveillance among key populations in the context of widespread HIV epidemics. Overall, the data reviewed here demonstrate that the dynamics of HIV in Africa are complex and achieving an AIDS-free generation necessitates acceptance of that complexity in all HIV surveillance, research, and prevention, treatment, and care programs.
Amniotic Fluid Embolism (AFE): A Review of the Literature Orientated on Two Clinical Presentations—Typical and Atypical  [PDF]
Waldemar Uszyński, Mieczys?aw Uszyński
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.41010
Abstract:

Background/Aim: Recently, a comparative study on the incidence of AFE has highlighted rather confusing results, showing that the complication is more than three times higher in North America than that in some European countries. In this paper, we put forward the hypothesis that this discrepancy is due to inaccurate diagnosis of non-classical form of AFE (atypical AFE). We also provide an outline of symptoms that characterize this type of AFE based on the analysis of all available case reports. Material and Methods: We searched Medline from 1969 (its inception) to 2011, using the key words “amniotic fluid embolism”. The search produced 1127 articles, including 208 case reports of AFE and other publications identified as eligible for our study (11 review articles and 6 population-based studies of the last few years). Moreover, we looked through the articles from the period before “inception of Medline” to find 178 earlier case reports. Full texts were analyzed. Results and Conclusions: (i) Worldwide, 447 cases of AFE have been reported, including 70 cases of atypical AFE (15.7%). (ii) Typical AFE is characterized by three clinical phases (cardiopulmonary collapse, clotting disorders and hemorrhages, multiorgan disturbances), whereas the atypical one shows lack of cardiopulmonary collapse as the initial presentation—the first to appear is obstetric hemorrhage and/or pulmonary and renal dysfunction. (iii) Four subclasses of atypical AFE were distinguished on the basis of case reports: uterine hemorrhage-type of AFE, ARDS as the only presentation of atypical AFE, paradoxical AFE, and cesarean section-related atypical AFEs.

Field Epidemiology and Laboratory Training Programs in sub-Saharan Africa from 2004 to 2010: need, the process, and prospects
P Nsubuga, K Johnson, C Tetteh, J Oundo, A Weathers, J Vaughan, S Elbon, M Tshimanga, F Ndugulile, C Ohuabunwo, M Evering-Watley, F Mosha, O Oleribe, P Nguku, L Davis, N Preacely, R Luce, S Antara, H Imara, Y Ndjakani, T Doyle, Y Espinosa, D Kazambu, D Delissaint, J Ngulefac, K Njenga
Pan African Medical Journal , 2011,
Abstract: As of 2010 sub-Saharan Africa had approximately 865 million inhabitants living with numerous public health challenges. Several public health initiatives [e.g., the United States (US) President’s Emergency Plan for AIDS Relief and the US President’s Malaria Initiative] have been very successful at reducing mortality from priority diseases. A competently trained public health workforce that can operate multi-disease surveillance and response systems is necessary to build upon and sustain these successes and to address other public health problems. Sub-Saharan Africa appears to have weathered the recent global economic downturn remarkably well and its increasing middle class may soon demand stronger public health systems to protect communities. The Epidemic Intelligence Service (EIS) program of the US Centers for Disease Control and Prevention (CDC) has been the backbone of public health surveillance and response in the US during its 60 years of existence. EIS has been adapted internationally to create the Field Epidemiology Training Program (FETP) in several countries. In the 1990s CDC and the Rockefeller Foundation collaborated with the Uganda and Zimbabwe ministries of health and local universities to create 2-year Public Health Schools Without Walls (PHSWOWs) which were based on the FETP model. In 2004 the FETP model was further adapted to create the Field Epidemiology and Laboratory Training Program (FELTP) in Kenya to conduct joint competencybased training for field epidemiologists and public health laboratory scientists providing a master’s degree to participants upon completion. The FELTP model has been implemented in several additional countries in sub-Saharan Africa. By the end of 2010 these 10 FELTPs and two PHSWOWs covered 613 million of the 865 million people in sub-Saharan Africa and had enrolled 743 public health professionals. We describe the process that we used to develop 10 FELTPs covering 15 countries in sub-Saharan Africa from 2004 to 2010 as a strategy to develop a locally trained public health workforce that can operate multi-disease surveillance and response systems.
Diabetes in Sub Saharan Africa 1999-2011: Epidemiology and public health implications. a systematic review
Victoria Hall, Reimar W Thomsen, Ole Henriksen, Nicolai Lohse
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-564
Abstract: We conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact.Type 2 diabetes accounts for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Proportions of patients with diabetic complications ranged from 7-63% for retinopathy, 27-66% for neuropathy, and 10-83% for microalbuminuria. Diabetes is likely to increase the risk of several important infections in the region, including tuberculosis, pneumonia and sepsis. Meanwhile, antiviral treatment for HIV increases the risk of obesity and insulin resistance. Five-year mortality proportions of patients with diabetes varied from 4-57%. Screening studies identified high proportions (> 40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient.Diabetes exerts a significant burden in the region, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high mortality and prevalence of complications observed. The significant interactions between diabetes and important infectious diseases highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.Sub-Saharan Africa
Epidemiology and interactions of Human Immunodeficiency Virus – 1 and Schistosoma mansoni in sub-Saharan Africa
Humphrey D Mazigo, Fred Nuwaha, Shona Wilson, Safari M Kinung'hi, Domenica Morona, Rebecca Waihenya, Jorg Heukelbach, David W Dunne
Infectious Diseases of Poverty , 2013, DOI: 10.1186/2049-9957-2-2
Abstract: Please see Additional file 1 for translations of the abstract into the six official working languages of the United Nations.Worldwide, HIV-1 infections remain a major public health problem. In 2010, over 31 million adult individuals (>15 years) were living with the disease and new cases of the disease were estimated to be at 2.7 million individuals [1]. The sub-Saharan African region continues to carry the largest proportion of the global disease burden [1]. In 2010, over 68% of global cases of HIV were in sub-Saharan Africa [1]. In this region, an estimated 1.9 million individuals were newly infected with HIV during 2010, comprising about 70% of all new cases of the disease worldwide [1]. However, in the East African region, the HIV epidemic has started to decline and has stabilized in some areas [2]. The national prevalence of HIV varies among countries in the region, from 3% in Rwanda, 5.8% in Tanzania, 6% in Kenya to 6-7% in Uganda [2,3]. The risk factors for HIV transmission in sub-Saharan Africa vary dramatically across sub-populations with different demographic characteristics [4,5]. The key risk factors for heterosexual transmission of HIV in Africa are commercial sex (prostitution), high population mobility, concurrent or multiple partners or number of lifetime sexual partners, residential location (rural versus urban), history of active or passive sexually-transmitted disease and lack of male circumcision [4,5]. Several epidemiological studies have reported vulnerable groups such as female bar workers [6], female commercial sex workers, long-distance truck drivers and their partners [7]. Fishing communities remain at higher risk of acquiring and transmitting HIV, and play a key role in the spread of HIV and in the maintenance of the HIV infection levels in the population [8,9].Schistosomiasis is a chronic, water-borne helminth disease, endemic in Africa for many centuries [10-12]. The current global estimate indicates that 779 million people in 76 countrie
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