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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
AFRICA
21
out anaemia (
p
<
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);
p
=
0.038], atrial
fibrillation [4.12 (1.60–10.61);
p
=
0.003], left ventricular ejec-
tion fraction
<
45% [2.70 (1.5 –4.67);
p
<
0.001] and negatively
associated with creatinine clearance (ORs per unit decrease)
[0.98 (0.97–0.99);
p
=
0.012] and total cholesterol level [0.78
(0.63–0.98);
p
=
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;
p
=
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*
1
, Lund Lars
2
, Makani Julie
1
1
Muhimbili University of Health and Allied Sciences, Dar es
Salaam, Tanzania;
makubi55@gmail.com2
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
1
, Selnow Gary
2
*Machakos Level 5 Hospital, Kenya;
dunmatheka@gmail.com1
University of Nairobi, Kenya
2
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 (
n
=
100) and experimental (
n
=
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;
p
<
0.001). The follow-up test results were 15.7
±
2.7 for experi-
mental and 10.4
±
2.4 marks for the control,
p
<
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.