Abstract
BackgroundThe burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa.MethodsWe searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I2 statistic.FindingsIn the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines.InterpretationCompared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity.FundingThis research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
Highlights
The prevalence of non-communicable diseases (NCDs) remains a growing concern globally, with a burgeoningNCD burden in low- and middle-income countries (LMICs).[1]
Search results were screened for duplicates by title and abstract screening; 1516 of the 1576 articles were excluded as they did not focus on or report paediatric hypertension or were conducted outside of Africa
Reasons for the exclusion of the remaining 7 articles were: Blood pressure (BP) was self-reported and not measured (n=1) (Letamo et al),[26] the study sample spanned outside the desirable age range in which no age specific data could be extracted (n=2) (Bhimma et al,[27] Mokgwathi et al28), the study was not conducted within an African population residing in Africa (n=2) (South et al,[29] South et al30) and no extractable information regarding hypertension could be extracted from the results (n=2) (Muyumba et al,[31] Mphekgwana et al32) (Figure 1)
Summary
NCD burden in low- and middle-income countries (LMICs).[1] According to the World Health Organization (WHO), cardiovascular disease (CVD) alone accounts for approximately 17.9 million NCD deaths annually,2 75% of which occurred in LMICs.[2] This increase in NCDs seen in LMICs, including in Africa, may result from “rapid, unplanned and unmanaged” urbanisation,[3] often associated with an increase in CVD risk factors such as dietary changes, increasingly sedentary lifestyles, increasing obesity, tobacco use and exposure to air pollutants.[3,4,5,6] The risks are evident in adults, and in children. Obesity in children and adolescents in Southern Africa has shown the largest proportional increase globally with a staggering 400%
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