In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational in...In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational interventions may reverse this trend. Using a pre-test/post-test design, in this study we investigated the effects of a structured cardiovascular health education program (CHEP) on treatment adherence, blood pressure (BP) control and body mass index (BMI) among Nigerian hypertensive patients who received guideline-based care in a rural primary care facility, in the context of a community based health insurance program. Study participants included 149 insured patients with uncontrolled BP and/or poor self-reported medication adherence after 12 months of guideline-based care. All patients received three group-based educational sessions and usual primary care over 6 months. We evaluated changes in self-reported adherence to prescribed medications and behavioral advice (primary outcomes);systolic BP (SBP) and/or diastolic BP (DBP) and BMI (secondary outcomes);and beliefs about hypertension and medications (explora- tory outcomes). Outcomes were analyzed with descriptive statistics and regression analysis. 140 patients completed the study (94%). At 6 months, more participants reported high adherence to medications and behavioral advice than at baseline: respectively, 101 (72%) versus 70 (50%), (p < 0.001) and 126 (90%) versus 106 (76%), (p < 0.001). Participants with controlled BP doubled from 34 (24%) to 65 (46%), (p = 0.001). The median SBP and DBP decreased from 129.0 to 122.0 mmHg, (p = 0.002) and from 80.0 to 73.5 mmHg, (p < 0.001), respectively. BMI did not change (p = 0.444). Improved medication adherence was associated with a decrease in medication concerns (p = 0.045) and improved medication self-efficacy (p < 0.001). By positively influencing patient perceptions of medications, CHEP strengthened medication adherence and, consequently, BP reduction among insured hypertensive Nigerians. This educational approach can support cardiovascular disease prevention programs for Africa’s growing hypertensive population.展开更多
Background and Aims:Metabolic-associated fatty liver disease(MAFLD)is driven by high caloric intake and sedentary lifestyle.Migration towards high income countries may induce these driving factors;yet,the influence of...Background and Aims:Metabolic-associated fatty liver disease(MAFLD)is driven by high caloric intake and sedentary lifestyle.Migration towards high income countries may induce these driving factors;yet,the influence of such on the prevalence of MAFLD is clearly understudied.Here,we investigated the Fatty Liver Index(FLI),a proxy of steatosis in MAFLD,after migration of Ghanaian subjects.Methods:Cross-sectional data of 5282 rural,urban and migrant participants from the Research on Obesity and Diabetes among African Migrants(also known as RODAM)study were analyzed with logistic regression for geographical differences in FLI and associations with type 2 diabetes mellitus(T2DM),waist-to-hip ratio,and 10-year predicted risk of atherosclerotic cardiovascular disease(ASCVD).Results:Both FLI and the proportion with an FLI indicative of MAFLD steatosis(FLI≥60)were higher in migrants compared with non-migrants.Prevalence of elevated FLI(FLI≥60)in non-migrant males was 4.2%compared to 28.9%in migrants.For females,a similar gradient was observed,from 13.6%to 36.6%respectively.Compared to rural residents,the odds for a FLI≥60 were higher in migrants living in urban Europe(odds ratio[OR]9.02,95%confidence interval[CI]:5.02–16.20 for men,and 4.00,95%CI:3.00–5.34 for women).Compared to controls,the ORs for FLI≥60 were 2.43(95%CI:1.73–3.41)for male T2DM cases and 2.02(95%CI:1.52–2.69)for female T2DM cases.One-unit higher FLI was associated with an elevated(≥7.5%)10-year ASCVD risk(OR:1.051,95%CI:1.041–1.062 for men,and 1.020,95%CI:1.015–1.026 for women).Conclusions:FLI as a proxy for MAFLD increased stepwise in Ghanaians from rural areas,through urban areas,to Europe.Our results clearly warrant awareness for MAFLD in migrant population as well as confirmation with imaging modalities.展开更多
文摘In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational interventions may reverse this trend. Using a pre-test/post-test design, in this study we investigated the effects of a structured cardiovascular health education program (CHEP) on treatment adherence, blood pressure (BP) control and body mass index (BMI) among Nigerian hypertensive patients who received guideline-based care in a rural primary care facility, in the context of a community based health insurance program. Study participants included 149 insured patients with uncontrolled BP and/or poor self-reported medication adherence after 12 months of guideline-based care. All patients received three group-based educational sessions and usual primary care over 6 months. We evaluated changes in self-reported adherence to prescribed medications and behavioral advice (primary outcomes);systolic BP (SBP) and/or diastolic BP (DBP) and BMI (secondary outcomes);and beliefs about hypertension and medications (explora- tory outcomes). Outcomes were analyzed with descriptive statistics and regression analysis. 140 patients completed the study (94%). At 6 months, more participants reported high adherence to medications and behavioral advice than at baseline: respectively, 101 (72%) versus 70 (50%), (p < 0.001) and 126 (90%) versus 106 (76%), (p < 0.001). Participants with controlled BP doubled from 34 (24%) to 65 (46%), (p = 0.001). The median SBP and DBP decreased from 129.0 to 122.0 mmHg, (p = 0.002) and from 80.0 to 73.5 mmHg, (p < 0.001), respectively. BMI did not change (p = 0.444). Improved medication adherence was associated with a decrease in medication concerns (p = 0.045) and improved medication self-efficacy (p < 0.001). By positively influencing patient perceptions of medications, CHEP strengthened medication adherence and, consequently, BP reduction among insured hypertensive Nigerians. This educational approach can support cardiovascular disease prevention programs for Africa’s growing hypertensive population.
基金This work was supported by the European Commission under the Framework Programme(Grant No.278901)The study sponsor was not involved in the design of the study+3 种基金the collection,analysis and interpretation of datawriting the reportnor the decision to submit the report for publication.AGH was supported by the Amsterdam UMC Fellowship grant,a Holland Health TKI-PPP grant and by research grants from Gilead and Novo Nordisk.KACM was supported by the Intramural Research Program of the National Institutes of Health in the Center for Research on Genomics and Global Health(CRGGH)The CRGGH was supported by the National Human Genome Research Institute,the National Institute of Diabetes and Digestive and Kidney Diseases,the Center for Information Technology,and the Office of the Director at the National Institutes of Health(No.1ZIAHG200362).
文摘Background and Aims:Metabolic-associated fatty liver disease(MAFLD)is driven by high caloric intake and sedentary lifestyle.Migration towards high income countries may induce these driving factors;yet,the influence of such on the prevalence of MAFLD is clearly understudied.Here,we investigated the Fatty Liver Index(FLI),a proxy of steatosis in MAFLD,after migration of Ghanaian subjects.Methods:Cross-sectional data of 5282 rural,urban and migrant participants from the Research on Obesity and Diabetes among African Migrants(also known as RODAM)study were analyzed with logistic regression for geographical differences in FLI and associations with type 2 diabetes mellitus(T2DM),waist-to-hip ratio,and 10-year predicted risk of atherosclerotic cardiovascular disease(ASCVD).Results:Both FLI and the proportion with an FLI indicative of MAFLD steatosis(FLI≥60)were higher in migrants compared with non-migrants.Prevalence of elevated FLI(FLI≥60)in non-migrant males was 4.2%compared to 28.9%in migrants.For females,a similar gradient was observed,from 13.6%to 36.6%respectively.Compared to rural residents,the odds for a FLI≥60 were higher in migrants living in urban Europe(odds ratio[OR]9.02,95%confidence interval[CI]:5.02–16.20 for men,and 4.00,95%CI:3.00–5.34 for women).Compared to controls,the ORs for FLI≥60 were 2.43(95%CI:1.73–3.41)for male T2DM cases and 2.02(95%CI:1.52–2.69)for female T2DM cases.One-unit higher FLI was associated with an elevated(≥7.5%)10-year ASCVD risk(OR:1.051,95%CI:1.041–1.062 for men,and 1.020,95%CI:1.015–1.026 for women).Conclusions:FLI as a proxy for MAFLD increased stepwise in Ghanaians from rural areas,through urban areas,to Europe.Our results clearly warrant awareness for MAFLD in migrant population as well as confirmation with imaging modalities.
