Suchergebnisse

The prevalence of some noncommunicable diseases (NCDs) in East Africa is beginning to match that in high-income countries. Though the epidemiologic, demographic, and nutritional transitions are well under way in low-income countries, investment and attention in these countries remain focused largely on communicable diseases. We discuss existing infrastructure in communicable disease management as well as linkages between noncommunicable and communicable diseases in East Africa. We describe gaps in NCD management within the health systems in East Africa. We also discuss deficiencies in addressing NCDs from basic science research and medical training to health service delivery, public health initiatives and access to essential medications in East Africa. Finally, we highlight the role of collaboration among East African governments and civil society in addressing NCDs and advocate for a robust primary healthcare system that focuses on the social determinants of health.

Objective: To describe the rationale and design of a prospective study of ambula­tory blood pressure measurement (ABPM) combined with measurement of contextual factors to identify hypertensive phenotypes in a Caribbean population with high rates of HTN and cardiovascular disease.Design: Prospective, multi-center sub-study.Setting: Eastern Caribbean Health Outcomes Research Network Cohort (ECHORN) Study, with study sites in Puerto Rico, the US Virgin Islands, Trinidad and Tobago, and Barbados.Participants: Community-residing adults without a diagnosis of HTN and not taking antihypertensive medication.Intervention: Ambulatory BP patterns are assessed using 24-hour ABPM. Contextual factors are assessed with: ecological mo­mentary assessment (7-item survey of expe­riences, exposures and responses associated with daytime BP measurements); actigra­phy (capturing physical activity and sleep quality); and self-report surveys (assessing physical and social health, environmental and social stressors and supports).Main Outcome Measures: Phenotypes of contextual factors associated with hyperten­sive BP patterns (sustained HTN, masked HTN, and nocturnal non-dipping)Methods and Results: This study will enroll 500 participants; assessments of blood pressure and contextual factors will be conducted during Waves 2 and 3 of the ECHORN parent study, occurring 2 years apart. In Wave 2, we will assess the associa­tion between contextual factors and ABPM patterns. Using advanced analytic clustering methods, we will identify phenotypes of contextual factors associated with hyper­tensive ABPM patterns. We will then test the stability of these phenotypes and their ability to predict change in ABPM patterns between Waves 2 and 3.Conclusions: Assessment of ABPM, and the contextual factors influencing ABPM, can identify unique phenotypes of HTN, which can then be used to develop more preci­sion-based approaches to the prevention, detection and treatment of HTN in high-risk populations.Ethn Dis. 2019;29(4):535-544; doi:10.18865/ed.29.4.535

Research Letter Introduction: Measures to limit the spread of COVID-19, such as movement restrictions, are anticipated to worsen outcomes for chronic conditions such as hypertension (HTN), in part due to decreased access to medicines. However, the actual impact of lockdowns on access to medicines and HTN control has not been reported. Between March 25 and June 30, 2020, the Government of Uganda instituted a nationwide lockdown. Health facilities remained open, however motor vehicle transportation was largely banned. In Ugandan public health facilities, HTN services are offered widely, however the availability of HTN medicines is generally low and inconsistent. In contrast, antiretrovirals for people with HIV (PWH) are free and consistently available at HIV clinics. We sought to evaluate the impact of the lockdown on access to medicines and clinical outcomes among a cohort of Ugandan patients with HTN and HIV.