Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015

AFRICA

out anaemia (

0.001). Normocytic anaemia was seen in 18%

of the patients while none had macrocytic anaemia. The risk of

having anaemia was positively associated with residency outside

Dar es Salaam [OR 1.72 (95% CI 1.02–2.89);

0.038], atrial

fibrillation [4.12 (1.60–10.61);

0.003], left ventricular ejec-

tion fraction

45% [2.70 (1.5 –4.67);

0.001] and negatively

associated with creatinine clearance (ORs per unit decrease)

[0.98 (0.97–0.99);

0.012] and total cholesterol level [0.78

(0.63–0.98);

0.029].

The one-year survival free from severe HF outcome was 70%.

The presence of ID anaemia increased the likelihood for a HF

event [HR 2.67; 95% CI 1.39–5.07;

0.003], while anaemia

without ID did not influence the risk.

Conclusion:

Iron-deficiency anaemia was common in Tanzanian

patients with HF and was independently associated with the risk

for hospitalisation or death.

RATIONALE AND DESIGN OF THE ROLE OF ORAL

IRON IN PATIENTS WITH HEART FAILURE AND IRON

DEFICIENCY IN TANZANIA: THE PROSPECTIVE

TANZANIA HEART FAILURE PILOT ORAL IRON CLINI-

CAL TRIAL (TaHeFII)

Makubi Abel*

, Lund Lars

, Makani Julie

Muhimbili University of Health and Allied Sciences, Dar es

Salaam, Tanzania;

makubi55@gmail.com

Karolinska institute,

Sweden

Introduction:

In patients with chronic heart failure (HF), iron

deficiency is common and associated with increased morbidity

and mortality rates, independent of anaemia. Intravenous (iv)

iron does improve quality of life and may reduce HF hospitali-

sation. However, iv iron is expensive and administration to large

populations of HF patient is therefore not infeasible, particu-

larly in countries with limited healthcare resources.

Oral iron is an established therapy for treating iron defi-

ciency but has not been widely tested in HF patients. Oral iron

remains promising in resource-limited settings because (1) it

is easily available, (2) easy to administer to patients, (3) newer

ferrous sulphate preparations may be better absorbed than older

ferrous sucrose, (4) the pathophysiology of iron deficiency may

differ geographically, and (5) oral iron is inexpensive. In view

of this, we will assess whether addition of oral iron therapy to

the conventional therapy improves haematological, myocardial,

biochemical and clinical parameters in adult patients with HF

and iron deficiency. This is a pilot study for a possible future

large, randomised clinical trial.

Methods:

This is a single-centre, prospective, open-label, uncon-

trolled clinical trial. A total of 150 individuals with stable chron-

ic HF and iron deficiency (with or without anaemia) are being

piloted at Muhimbili cardiovascular centre in Dar es Salaam, for

the period of eight months (January to August 2015.) Eligible

patients will receive a fixed-dose oral iron sulphate therapy (200

mg), given three times a day for three months. The endpoint will

be improvement in mean serum ferritin, left ventricular size and

ejection fraction, six-minute walk distance, and NT-proBNP

and haemoglobin levels at the end of three months, compared

to baseline levels.

Conclusion:

Should this pilot study become successful, it will

pave way to a full randomised, controlled trial, which might

determine the beneficial effect of oral iron in HF, thus improv-

ing the prognosis of this population.

ROLE OF TECHNOLOGY IN CREATING RHEUMAT-

IC HEART DISEASE AWARENESS AMONG SCHOOL-

GOING CHILDREN IN KENYA

Matheka Duncan*, Murgor Mellany

, Selnow Gary

*Machakos Level 5 Hospital, Kenya;

dunmatheka@gmail.com

University of Nairobi, Kenya

WiRED International

Introduction:

Rheumatic heart disease (RHD) is the most

common cardiovascular disease in Kenya and mainly affects

school-going children. As a preventable disease, its incidence

may be significantly reduced by educating the community on

preventative measures. Educating children is crucial in combat-

ing the disease since they are especially vulnerable to streptococ-

cal infection. The role of innovative training approaches (tech-

nology based) among school-going children remains unverified.

Objective:

The current project therefore sought to train school-

going children on RHD using an interactive digital module

from WiRED International, a US-based non-profit organisa-

tion working in Kenya.

Methods:

The module offered simplified animated presenta-

tions linking sore throat, rheumatic fever and RHD, as well as

ways of their prevention. The module also introduced questions

throughout the presentation and provided instant feedback to

reinforce key concepts.

Upper primary school pupils from two schools were random-

ly assigned into control (

100) and experimental (

100)

groups. The experimental group was trained using the module,

while the control group did not have any teaching. Both groups

then answered 23 multiple-choice questions (MCQs). During a

follow-up visit one week later, the students were re-administered

with the same final examination. The results were analysed

using SPSS version 16.0.

Results:

The mean age of the pupils was 12.71 years. On the

first test, the experimental group had higher average scores

compared to the control group (16.3

2.5 vs 10.5

2.3 marks;

0.001). The follow-up test results were 15.7

2.7 for experi-

mental and 10.4

2.4 marks for the control,

0.001. Age, class

level or gender did not affect their performance.

Conclusion:

The use of interactive digital modules to train

school-going children on RHD increases knowledge, aware-

ness and is feasible, efficacious and sustainable. This approach

is beneficial, and could potentially reduce the toll of RHD

if tailored to the specific learning needs of the children and

applied more widely.