sub-Saharan African Adults Research Articles

DIETARY BEHAVIORS OF AFRICAN IMMIGRANTS LIVING WITH DIABETES AND/OR HYPERTENSION: A QUALITATIVE STUDY

Abstract Healthy dietary behaviors (e.g., low-salt diet) are a critical element of self-care and the cornerstone in managing diabetes and/or hypertension. Social determinants (e.g., cultural preferences and social support) influence dietary behaviors. However, little is known about the influence of social determinants on dietary behaviors of African immigrants living with diabetes and/or hypertension accounting for their level of acculturation. We conducted a descriptive qualitative study of a purposive sample of 24 self-identified sub-Saharan African immigrant adults in the Northeastern U.S. with symptomatic hypertension and/or diabetes who spoke and understood English. Based on scores from the Short Acculturation Scale, African immigrants were classified as more or less acculturated. The sample was mainly Nigerian (75%) and males (67%), with a mean age of 59 years [40-72]. The sample was highly educated, acculturated, employed, and reported having enough income to meet their needs. Compared to more-acculturated immigrants, less-acculturated immigrants regularly ate more African or “traditional food,” vegetables and rice, and avoided salt and fatty/fast/processed American foods. Less-acculturated immigrants cooked their meals and learned their diets from previous education or their workplace. Compared to the less acculturated, more acculturated participants ate fruits regularly and avoided meat or red meat. Interestingly, the more acculturated participants reported learning about their diet from family and friends and noted that family members cook the meals in their household. Interventions to promote healthy diets among immigrants should take into consideration cultural dietary preferences, influence of family, friends, and non-familial social connections, and level of acculturation.

Abstract 4141453: The Pandemic influenced the Self-care of African Immigrants with Diabetes and Hypertension

Background: Self-Care is essential for chronic illness management. Self-Care comprises three domains: Self-Care maintenance (daily behaviors to maintain health [e.g., medication adherence]), Self-Care monitoring (surveillance for changes), and (3) Self-Care management (prompt response to symptoms). The COVID-19 pandemic challenged self-care in some populations, but little is known about how it influenced the self-care of African immigrants living in the US with chronic illnesses such as hypertension and diabetes. Methods: Using a qualitative descriptive design, we enrolled a purposeful sample of 24 sub-Saharan African immigrant adults with self-reported symptomatic hypertension or diabetes. Participants who spoke English were enrolled between March 2020 and September 2021. Individual audio-taped interviews were transcribed and analyzed. Inductive and deductive thematic analysis was guided by the Theory of Self-Care of Chronic Illness. Results: Participants were mean=59 years (range 40-72). Most were Nigerian (n=16), male (n=16), married (n=17), living with family (n=21), highly educated (n=21), and reporting enough income to meet their needs (n=21). Five major themes were identified: (1) Being especially careful in following COVID-19 precautions (e.g., use of facemasks). (2) A focus on self-care maintenance (e.g., healthy diet, staying active while at home). Fear of COVID-19 increased medication adherence. Participants were diligent in taking medications as prescribed due to fear of COVID-19. (3) Close monitoring for symptoms. (4) Trouble reaching providers to discuss symptoms. (5) Access to resources. Participants reported loss of health insurance/jobs and lack of provider access, which impacted their ability to perform self-care. Conclusions: COVID-19 increased focused attention on self-care but also created barriers for sub-Saharan African Immigrants. Most impacted was self-care maintenance. Interventions to promote self-care in this population should leverage heightened vigilance to self-care and address challenges around access to resources.

Roles of Loneliness, Stress, and Religiosity in Suicide Ideation Among Nigerian Older Adults.

Suicidal behavior in older adults is a fundamental public health problem globally and the highest suicide rates occur in low- and middle-income countries (LMICs). However, there is limited research on suicidality among older adults, especially in sub-Saharan Africa. We sought to find out whether loneliness, stress and religiosity would be associated with suicide ideation in a sample of sub-Saharan African older adults (N = 500; aged 51-70 years, Mage = 58.97, SD = 6.16; 45.6% women). They completed the Beck Suicidal Ideation Scale, the UCLA Loneliness Scale-version 3, Perceived Stress Scale, and Religiosity Scale. Regression results showed that whereas suicidal ideation could be increased by loneliness and stress, religious older adults were less likely to report suicidal ideation. Interventions aimed at managing and protecting the mental health of older adults during their transition to late adulthood should guard them against loneliness and buffer their resilience and coping strategies with the connectedness that religiosity offers.

Deciphering Vascular Dynamics Alterations in Sub-Saharan Individuals with Type 2 Diabetes: Overview and Temporal Analysis of Nitric Oxide Administration

Background: Early detection of arterial damage is essential for the primary prevention of complications linked to type 2 diabetes (T2D). The study assessed the cardiovascular risk of sub-Saharan African individuals with T2D, while exploring possible mechanisms involved in the pathogenesis of vascular complications in this population. Methodology: A crossover study of 72 sub-Saharan African adults (36 with T2D and 36 without T2D) was conducted. Outcomes including diameter size (mm) and blood velocity (cm/s) of the brachial artery, were obtained at seven time points: baseline and from 5 seconds to 600 seconds in two conditions: pre- and post Nitric Oxide (NO) administration. HbA1C, fasting glucose, age, BMI, mean arterial pressure (MAP), lipid profile, T2D duration since diagnosis, and binary indicators of insulin and oral diabetes medication were evaluated. Results: NO improved the blood flow compared to the pre-NO after adjustment for clinical factors. The beneficial effect of NO administration on vascular dynamics was influenced by age (<I>B</I>=1.09; 95%IC: 1.07, 1.11), increased BMI (<I>B</I>= 1.03; 95%IC: 1.01, 1.04) and insulin use (<I>B</I> = 1.13; 95%IC 1.10, 1.16). Conclusion: The nuanced impact of these factors on blood flow improvement related to NO necessitates tailored and personalized approaches in managing T2D patients.

HLA-A*23 Is Associated With Lower Odds of Acute Retroviral Syndrome in Human Immunodeficiency Virus Type 1 Infection: A Multicenter Sub-Saharan African Study.

The role of human leukocyte antigen (HLA) class I and killer immunoglobulin-like receptor molecules in mediating acute retroviral syndrome (ARS) during human immunodeficiency virus type 1 (HIV-1) infection is unclear. Among 72 sub-Saharan African adults, HLA-A*23 was associated with lower odds of ARS (adjusted odds ratio, 0.10 [95% confidence interval, .01-.48]; P = .009), which warrants further studies to explore its role on HIV-1-specific immunopathogenesis.

Mapping Evidence on the Epidemiology and Cost Associated with Maxillofacial Injury among Adults in Sub-Saharan Africa: A Scoping Review Protocol.

(1) Background: Maxillofacial injury (MI) occurs universally, for it disregards preference for age, gender, and geographical region. The global incidence and prevalence of facial fractures rose by 39.45% and 54.39%, respectively, between the years 1990 to 2017. Projections indicate that the burden of injuries will persist in sub-Saharan Africa (SSA) in the next twenty years. This scoping review aims to map the literature on MI epidemiology and the economic burden on society in SSA. (2) Methods: The methodology presented by Arksey and O'Malley and extended by Levac and colleagues will be employed in the scoping review. The researcher will report the proposed review through the Preferred Reporting Items for Systematic Review, and Meta-Analysis extension for scoping reviews (PRISMA-ScR). The review will include studies encompassing MI in sub-Saharan African adults 18 years and above. (3) Results: This will be presented as a thematic analysis of the data extracted from the included studies, and the Nvivo version 12 will be employed. (4) Discussion: We anticipate searching for related literature on the prevalence, incidence, risk factors, mortality, and cost associated with MI in the adult population of SSA. The conclusion from the review will assist in ascertaining research gaps, informing policy, planning, authorizing upcoming research, and prioritizing funding for injury prevention and management.

Abstract A093: Cancer risk factors awareness and cancer perceptions among African Americans and Sub-Saharan African immigrants

Abstract Background: Cancer risk factors awareness and cancer perceptions may influence individuals’ engagement or lack of engagement in preventive health behaviors including cancer screening and lifestyle changes. Blacks in the US have disproportionately higher death rates and the shortest survival rates than any ethnic or racial group for most cancers. Many factors may contribute to the elevated cancer burden, including level of awareness of cancer lifestyle risk factors and negative cancer perceptions. However, further research is needed to know more about cancer risk awareness and perceptions among ethnic sub-groups of Blacks. Therefore, the objective of this study was to assess awareness of cancer risk factors and cancer perceptions among African Americans and sub-Saharan African immigrant adults. Methods: We conducted a cross-sectional self-administered survey of 109 African Americans and 88 sub-Saharan African Black adults recruited from a medium size city in the Southeastern US and surrounding towns. Data collected included sociodemographics, measures of cancer risk awareness, and cancer perceptions. Linear regression models evaluated associations among sociodemographics and cancer risk factor awareness and cancer perceptions variables. Results: Participants’ average age was 41.5 years (SD=12.9), the majority were female (59%), and (45%) self-identified as sub-Saharan African immigrants. Based on a list of 13 cancer risk factors, the average number identified correctly was 6.5 (SD = 3.3). For cancer risk perceptions, with higher scores reflecting more negative cancer perceptions, scores were moderate (M = 13.8, SD = 2.8; potential range 5-25). Age, insurance status, education, and financial comfort were significantly associated with cancer risk factor awareness. For cancer risk perceptions, insurance status, education, and financial comfort were significant in the unadjusted analysis. Education was the only significant predictor for each outcome. Every one-level increase in educational attainment was associated with a 0.5-point increase in cancer risk factor awareness (b = 0.499, SD = 0.229; p = .031) and a 0.5-point decrease in cancer risk perception scores (b = -0.500, SE = 0.201; p = .014). Age, gender, ethnicity, marital status, insurance status, and financial comfort were not associated with either outcome in the adjusted model. Conclusion: Additional research is needed to improve cancer awareness and perceptions among Black adults. Future research should target women at higher risk of low awareness of cancer risk factors and negative cancer perceptions due to lower educational attainment. Increased attention to health promotion using different avenues and ensuring literacy may improve awareness of cancer risk factors and cancer risk perceptions. Citation Format: Adebola Adegboyega, Adaeze Aroh, Amanda Wiggins, Mark Dignan. Cancer risk factors awareness and cancer perceptions among African Americans and Sub-Saharan African immigrants [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A093.

Beliefs associated with cancer screening behaviors among African Americans and Sub-Saharan African immigrant adults: a cross-sectional study

BackgroundBeliefs influence cancer screening. However, there are conflicting findings about how belief influence cancer screening among Black adults. The aim of this study was to evaluate the relationships between beliefs (religiosity, fatalism, temporal orientation, and acculturation) and cervical, breast, and colorectal cancer screening behaviors among African Americans and sub-Saharan African immigrants.MethodsWe conducted a cross-sectional survey of 73 African American and 59 English speaking Sub-Saharan immigrant adults recruited from Lexington and surrounding cities in Kentucky. Data collected included sociodemographic variables, cancer screening behaviors, and several instruments that characterize beliefs, including religiosity, fatalism, temporal orientation, and acculturation.ResultsParticipants’ mean age was 43.73 years (SD = 14.0), 83% were females, and 45% self-identified as sub-Saharan immigrants. Based on eligibility for each screening modality, 64% reported having ever had a Pap test, 82% reported ever having mammogram, and 71% reported ever having a colonoscopy. Higher education (OR = 2.62, 95% CI = 1.43—4.80) and being insured (OR = 4.09, 95% CI = 1.10 – 15.18) were associated with increased odds of cervical cancer screening (pap test), while cancer fatalism (OR = 0.24, 95% CI = 0.07 – 0.88) was associated with decreased odds. Increased age (OR = 1.57, 95% CI = 1.06 – 2.32) and reduced present orientation (OR = 0.42, 95% CI = 0.22 – 0.80) were associated with receipt of a mammogram. Nativity was the only factor associated with colonoscopy screening. Compared to African Americans, sub-Saharan African immigrants were 90% less likely to have had a colonoscopy (OR = 0.10, 95% CI = 0.02 – 0.66).ConclusionThis study contributes to the existing literature by confirming that beliefs are important in cancer screening behaviors among African American and sub-Saharan African immigrants. These findings should inform the development of cancer control and prevention programs for Black adults.Trial registrationUS National Library of Science identifier NCT04927494. Registered June 16, 2021, www.clinicaltrials.gov

Simple noninvasive tests for liver fibrosis diagnosis in sub-Saharan African adults with chronic viral hepatitis B or C: A cross sectional study in Cameroon

Background and aimsThis study aimed at measure the correlation between simple less expensive and noninvasive tests for liver fibrosis and Fibrotest among patients with chronic hepatitis B (HBV) or C (HCV) in resource-limited settings. Materials and methodsThis was a cross-sectional study conducted at the Centre Pasteur of Cameroon among adults with chronic HBV or HCV infection. The correlation between aspartate aminotransferase to platelet ratio index(APRI), the gamma-glutamyl transferase to platelet ratio (GPR), and Fibrosis-4 score (FIB-4); and Fibrotest was assessed using the Spearman rank test providing the rho (ρ) coefficient of correlation. ResultsOf the 52 patients (mean age: 49 years, males: 51.9%) included, 52% were infected with HBV (n = 27). The APRI, GPR, FIB-4, and Fibrotest median scores (25th-75th percentiles) were: 0.37 (0.25–0.64), 0.34 (0.20–1.45), 1.49 (0.88–3.12), and 0.43 (0.21–0.80), respectively. The correlation with Fibrotest were: APRI (ρ = 0.678, p value < 0.0001), GPR (ρ = 0.621, p value < 0.0001) and FIB-4 (ρ = 0.772, p value < 0.0001). ConclusionsThis study found a significant correlation between APRI, GPR and FIB-4; and Fibrotest among patients with chronic HBV or HCV infection in Cameroon. FIB-4 appeared as the diagnosis method with the strongest correlation with Fibrotest.

Prevalence and Factors Associated with Acute Kidney Injury in Sub-Saharan African Adults: A Review of the Current Literature.

Acute kidney injury (AKI) is a complex condition that can occur in both community and hospital settings and has many aetiologies. These aetiologies may be infectious, toxic, surgical, or related to the different management methods. Although it is a major public health problem worldwide, it must be emphasised that both its incidence and mortality rate appear to be very high in sub-Saharan African (SSA) countries compared to developed countries. The profile of AKI is very different from that of more developed countries. There are no reliable statistics on the incidence of AKI in SSA. Infections (malaria, HIV, diarrhoeal, and other diseases), nephrotoxins, and obstetric and surgical complications are the main aetiologies in Africa. The management of AKI is costly and associated with high rates of prolonged hospitalisation and in-hospital mortality.

Cross-country variations in the reporting of psychotic symptoms among sub-Saharan African adults: A psychometric evaluation of the Psychosis Screening Questionnaire

BackgroundSelf-reporting of psychotic symptoms varies significantly between cultures and ethnic groups. Yet, limited validated screening instruments are available to capture such differences in the African continent. MethodologyAmong 9,059 individuals participating as controls in a multi-country case–control study of the genetic causes of psychosis, we evaluated the psychometric properties of the Psychosis Screening Questionnaire (PSQ). We applied multi-group confirmatory factor analysis and item response theory to assess item parameters. ResultsThe overall positive endorsement of at least one item assessing psychotic symptoms on the PSQ was 9.7%, with variability among countries (Uganda 13.7%, South Africa 11%, Kenya 10.2%, and Ethiopia 2.8%). A unidimensional model demonstrated good fit for the PSQ (root mean square error of approximation = 0.009; comparative fit index = 0.997; and Tucker-Lewis Index = 0.995). Hypomania had the weakest association with single latent factor (standardized factor loading 0.62). Sequential multi-group confirmatory factor analysis demonstrated that PSQ items were measured in equivalent ways across the four countries. PSQ items gave more information at higher levels of psychosis, with hypomania giving the least discriminating information. LimitationsParticipants were recruited from general medical facilities, so findings may not be generalizable to the general population. ConclusionThe PSQ demonstrated a unidimensional factor structure in these samples. Items were measured equivalently across all study settings, suggesting that differences in prevalence of psychotic symptoms between countries were less likely to represent measurement artifact. The PSQ is more reliable in screening for psychosis in individuals with higher degrees of psychotic experiences—hypomania excluded—and might decrease the false-positive rate from mild nonspecific psychotic experiences.

Association of cellular HIV-1 DNA and virological success of antiretroviral treatment in HIV-infected sub-Saharan African adults

BackgroundHIV-1 DNA persists in infected cells, forming viral reservoirs. Pre-antiretroviral treatment (ART) HIV-1 DNA load was reported to predict ART success in European severely immunocompromised patients. The aim of this study was to determine whether HIV-1 DNA levels are associated with virological success in less severely immunocompromised patients who receive early ART in sub-Saharan Africa.MethodsThe association between pre-ART HIV-1 DNA and the virological response after 30 months on ART was studied in multivariate logistic regression in patients randomised to immediate ART groups in the Temprano trial, which assessed the benefits of early ART in HIV-infected adults in Côte d’Ivoire. HIV-1 DNA was quantified in peripheral blood mononuclear cell (PBMC) using real-time PCR.ResultsHIV-1 DNA levels were measured in 1013 patients. Their medians [IQR] of pre-ART CD4 count, HIV-1 RNA and HIV-1 DNA levels were 465 [379–578]/mm3, 4.7 [4.0–5.3] log10 copies/ml and 2.9 [2.5–3.2] log10 copies/million PBMC, respectively. Pre-ART HIV-1 DNA was significantly correlated with pre-ART HIV-1 RNA (R = 0.59, p < 0.0001). In multivariate analysis, HIV-1 DNA < 3 log10 copies/million PBMC was significantly associated with virological success at M30 after adjustment for other key variables (ART regimen, IPT, sex, age, WHO clinical stage, CD4 and HIV-1 RNA; aOR 1.57; 95% CI 1.08–2.30; p = 0.02).ConclusionLow HIV-1 DNA was statistically associated with virological success in this population of sub-Saharan African adults who started treatment with a median pre-ART CD4 count at 465/mm3. HIV-1 DNA could become a useful tool for guiding some therapeutic decisions in the test-and-treat era.Trial registration TEMPRANO ANRS 12136 ClinicalTrials.gov, number NCT00495651, date of registration 03/07/2007.

The Association of Reproductive Aging with Cognitive Function in Sub-Saharan African Women.

Life expectancy in sub-Saharan African women is increasing, and by the late 2020s an estimated 76% of postmenopausal women globally will be living in developing countries. Menopause transition has been associated with cognitive decline in a wide range of studies, but data on cognition and reproductive aging are lacking in sub-Saharan African women. Approximately 72 million people in the region are expected to suffer from dementias and neurocognitive decline by 2050. Studies show that compromised cognitive health in low-income countries has significant implications for adult quality of life and socioeconomic development. There is now an urgent need to further examine risk factors for cognitive decline in these aging women and to understand the ability of public health programs to diagnose and treat cognitive dysfunction. This review examines studies assessing cognition and aging in sub-Saharan African adults, while addressing the significant research gaps. It examines data on the association of the menopause transition with cognitive function and describes how validated tools should be available to assess both menopausal stage and symptoms. Culturally appropriate and validated neurocognitive measures are required to better understand the relationship of reproductive aging with cognition. Longitudinal population-based studies are needed to assess the effect of lifestyle interventions, such as diet and exercise, on cognitive health in sub-Saharan African populations, with an emphasis on women as they transition into menopause.

Association of Plasma Soluble Vascular Cell Adhesion Molecule-1 and sCD14 With Mortality in HIV-1-Infected West African Adults With High CD4 Counts.

Several biomarkers of inflammation and coagulation were reported to be associated with HIV disease progression in different settings. In this article, we report the association between 11 biomarkers and medium-term mortality in HIV-infected West African adults. In Temprano ANRS 12136, antiretroviral therapy (ART)-naive HIV-infected adults with high CD4 counts were randomly assigned either to start ART immediately or defer ART until the World Health Organization criteria were met. Participants who completed the 30-month trial follow-up were invited to participate in a posttrial phase. The posttrial phase end point was all-cause death. We used multivariate Cox proportional models to analyze the association between baseline plasma biomarkers [IL-1ra, IL-6, soluble vascular cell adhesion molecule 1 (sVCAM-1), sCD14, D-dimer, fibrinogen, IP-10, sCD163, albumin, high-sensitivity C-reactive protein, and 16S rDNA] and all-cause death in the Temprano participants randomized to defer ART. Four hundred seventy-seven patients (median age 35 years, 78% women, and median CD4 count: 379 cells/mm) were randomly assigned to defer starting ART until the World Health Organization criteria were met. The participants were followed for 2646 person-years (median 5.8 years). In the follow-up, 89% of participants started ART and 30 died. In the multivariate analysis adjusted for the study center, sex, baseline CD4 count, isoniazid preventive therapy, plasma HIV-1 RNA, peripheral blood mononuclear cell HIV-1 DNA, and ART, the risk of death was significantly associated with baseline sVCAM-1 (≥1458 vs. <1458: adjusted hazard ratio 2.57, 95% confidence interval: 1.13 to 5.82) and sCD14 (≥2187 vs. <2187: adjusted hazard ratio 2.79, interquartile range 1.29-6.02) levels. In these sub-Saharan African adults with high CD4 counts, pre-ART plasma sVCAM-1 and sCD14 levels were independently associated with mortality.

Association of Plasma sVCAM-1 and sCD14 with Mortality in HIV-1 Infected West African Adults with High CD4 Counts

Background: Several biomarkers of inflammation and coagulation were reported to be associated with HIV disease progression in different settings. Here we report the association between eleven biomarkers and medium-term mortality in HIV-infected adults who participated in a trial of early antiretroviral therapy (ART) in West Africa (Temprano ANRS 12136). Methods: In Temprano, ART-naive HIV-infected adults with high CD4 counts were randomly assigned either to start ART immediately or defer ART until the WHO criteria were met. Participants who completed the 30-month trial follow-up were invited to participate in a post-trial phase (PTP). The PTP endpoint was all-cause death. We used multivariate Cox proportional models to analyze the association between baseline plasma biomarkers (IL-1ra, IL-6, sVCAM-1, sCD14, D-dimer, Fibrinogen, IP-10, sCD163, albumin, hsCRP, 16S rDNA) and all-cause death in the Temprano participants randomized to defer ART. Findings: 477 patients (median age 35, 78% women) were randomly assigned to defer starting ART until the WHO criteria were met. At baseline, the median CD4 count was 379 cells/mm3, the median plasma HIV-1 RNA level 4·6 log10 copies/mL and the median PBMC HIV-1 DNA level 3·0 log10 copies per million PBMC. The participants were followed for 2646 person-years (median 5·8 years). In the follow-up, 89% of participants started ART and 30 died. In the multivariate analysis adjusted for the study center, sex, baseline CD4 count, isoniazid preventive therapy, plasma HIV-1 RNA, PBMC HIV-1 DNA and ART, the risk of death was significantly associated with baseline sVCAM-1 (≥ 1458 vs. < 1458: adjusted hazard ratio [aHR] 2·57, 95% CI 1·13-5·82) and sCD14 (≥ 2187 vs. < 2187: aHR 2·79, IQR 1·29-6·02) levels. Interpretation: In these sub-Saharan African adults with high CD4 counts, pre-ART plasma sVCAM-1 and sCD14 levels were independently associated with mortality. Trial Registration: Registered at Clinical Trials.gov (NCT00495651). Funding Statement: French National Agency for AIDS and viral hepatitis research (ANRS, Paris, France; Grants ANRS 12136, ANRS 12224, ANRS 12253). Declaration of Interests: All authors report no conflict of interest. Ethics Approval Statement: The Temprano protocol, which included the post-trial phase, was approved by the Cote d'Ivoire National Ethics Committee for Health Research. All patients gave written informed consent.

Prevalence of major cardiovascular disease risk factors among a group of sub-Saharan African young adults: a population-based cross-sectional study in Yaoundé, Cameroon

ObjectiveTo determine the prevalence estimates of some major risk factors for cardiovascular disease (CVD) in a young adult-aged population living in Yaoundé, Cameroon.DesignA cross-sectional study held from May to July...

The Early Recognition and Management of Sepsis in Sub-Saharan African Adults: A Systematic Review and Meta-Analysis.

Sepsis is a common cause of morbidity and mortality in sub-Saharan African adults. Standardised management pathways have been documented to improve the survival of adults with sepsis from high-resource settings. Our aim was to assess the current evidence base for early sepsis interventions (recognition, empirical antibiotics, and resuscitation) in resource-poor settings of sub-Saharan Africa. We searched MEDLINE, EMBASE and CINHAL Plus databases to identify interventional studies for the early recognition and management of sepsis in sub-Saharan Africa (1 January 2000 to 1 August 2018) using a protocol-driven search strategy: adults, protocolised care pathway, and sub-Saharan Africa. We identified 725 publications of which three met criteria for final selection. Meta-analysis from two randomised controlled trials demonstrated that mortality was increased by ‘early goal-directed therapy’ interventions that increased fluid resuscitation (R.R. 1.26, 95% C.I. 1.00–1.58, p = 0.045; I2 53%). The third observational cohort study demonstrated improved survival after implementation of protocolised management for sepsis (mortality 33.0% vs. 45.7%, p = 0.005). No study incorporated standardised protocols for empirical antibiotic administration. High rates of pneumonia and mycobacteraemia were reported. There has been little research into the early recognition and management of sepsis in sub-Saharan Africa. Interventional trials of early goal-directed therapy have, to date, increased mortality. There is an urgent need to develop effective strategies to improve outcomes for adults with sepsis in sub-Saharan Africa.

Effectiveness of macronutrient supplementation on nutritional status and HIV/AIDS progression: A systematic review and meta-analysis

Malnutrition is common in Sub-Saharan Africa, weakening the immune function of persons living with HIV infection (PLWH). Being malnourished at the initiation of antiretroviral therapy (ART) leads to higher risk of early mortality and reduced quality of life. Thus, introduction of protein-energy-fortified macronutrient supplements at ART initiation may improve HIV treatment outcomes. This review aimed to evaluate the effectiveness of macronutrient interventions. This systematic review and meta-analysis included 15 studies conducted from 2000 to 2015 among Sub-Saharan African adults. Six randomized controlled trials and 4 retrospective cohort studies provided data eligible for a meta-analysis. Supplementation significantly increased the overall standardized mean difference (SMD) between baseline and follow-up data in weight (SMD=0.382, p<.001), BMI (SMD=0.799, p<.001); fat-free mass (SMD=0.154, p=.009); and CD4 count (SMD=0.428, p<.001). Protein-energy-fortified macronutrient supplementation at ART initiation may positively influence nutritional status and immunologic response in PLWH in Sub-Saharan Africa.

Goal directed therapy for suspected acute bacterial meningitis in adults and adolescents in sub-Saharan Africa.

BackgroundMortality from acute bacterial meningitis (ABM) in sub-Saharan African adults and adolescents exceeds 50%. We tested if Goal Directed Therapy (GDT) was feasible for adults and adolescents with clinically suspected ABM in Malawi.Materials and methodsSequential patient cohorts of adults and adolescents with clinically suspected ABM were recruited in the emergency department of a teaching hospital in Malawi using a before/after design. Routine care was monitored in year one (P1). In year two (P2), nurses delivered protocolised GDT (rapid antibiotics, airway support, oxygenation, seizure control and fluid resuscitation) to a second cohort. The primary endpoint was composite mean number of clinical goals attained. Secondary endpoints were individual goals attained and death or disability from proven or probable ABM at day 40.Results563 patients with suspected ABM were enrolled in the study; 273 were monitored in P1; 290 patients with suspected ABM received GDT in P2. 61% were male, median age 33 years and 90% were HIV co-infected. ABM was proven or probable in 132 (23%) patients. GDT attained more clinical goals compared to routine care: composite mean number of goals in P1 was 0·55 vs. 1·57 in P2 GDT (p<0·001); Death or disability by day 40 from proven or probable ABM occurred in 29/57 (51%) in P1 and 38/60 (63%) in P2 (p = 0·19).ConclusionNurse-led GDT in a resource-constrained setting was associated with improved delivery of protocolised care. Outcome was unaffected.Trial registrationwww.isrctn.com ISRCTN96218197

Non-compaction of left ventricular myocardium in sub-Saharan African adults

BackgroundNon-compaction of the left ventricle (NCLV) is an unclassified cardiomyopathy due to intrauterine arrest of compaction of the loose interwoven meshwork. Only a few studies involving sub-Saharan Africans insmall numbers...