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

25 / 56

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 AFRICA 23
There is a need to document GAS carriage in school children
of all ages, which, together with the molecular characterisation
(M-typing) of strains harboured in the pharynx of carriers,
will help to ascertain the extent to which disease strains are
prevalent among carriers. This background information would
serve to assist healthcare providers in diagnosing symptomatic
GAS pharyngitis, as well as potentially contributing to the
development of a GAS vaccine. Currently, data on prevalence
of GAS carriage and M-type distribution in African countries
are largely scant. We therefore undertook to perform a system-
atic review to determine the prevalence and type distribution of
asymptomatic streptococcus carriage in children aged five to 15
years, residing in African countries.
Methods: We conducted a comprehensive literature search
among a number of databases, using an African search filter to
identify GAS prevalence studies that report on children between
the ages of five and 15 years who reside in African countries.
Electronic searches were complemented by a hand-search
performed on reference lists of potentially included studies. The
search was not limited by year of publication and language.
Two evaluators independently reviewed, rated and abstracted
data from each article. Prevalence estimates were pooled in
a meta-analysis and stratified according to region and study
design, using Stata®. Specifically, we applied the random-effects
metaprop routine to aggregate prevalence estimates and account
for between-study variability in calculating the overall pooled
estimates and 95% CI for prevalence of GAS carriage.
Results: Of the 1 665 articles retrieved, 16 studies incorporat-
ing cross-sectional and longitudinal study designs met with the
inclusion criteria. The pooled prevalence of GAS carriage was
8% [95% confidence interval (CI), 5–10%] with pooled preva-
lences for cross-sectional studies equal to 8% (95% CI, 5–11%)
and longitudinal studies, 9% (95% CI, 1–24%). Regional pooled
rates were similar across East, Central and Southern Africa of
between 7 and 8%, while countries within northern Africa had
a pooled estimate of 14% (95% CI, 3–30%). Western Africa had
the lowest pooled estimate of 2% (95% CI, 1–2%). Only one
study reported data on molecular characterisation, of which
11/13 (85%) emm-types were included among the putative
30-valent vaccine currently under development.
Conclusion: This study revealed a pooled GAS carriage estimate
of 8% among African school children. Regional differences in
carriages were largely minimal except for West and North Africa
with prevalences of 2 and 14%, respectively. There is a dearth of
data on molecular strain information, therefore emphasising the
need for further studies.
CENTRALARTERIALSTIFFNESS INZAMBIANNORMO-
TENSIVE AND HYPERTENSIVE PARTICIPANTS
Mushabati Festus*1, Goma Fastone M2, Lwiindi Lukubi3,
Siulapwa Nathan J1, Siziya Sete1
*Copperbelt University, School of Medicine, Ndola, Zambia;
2University of Zambia, Zambia
3Lusaka Apex Medical University, Zambia
Background: Central arterial stiffness is a strong and independ-
ent predictor of cardiovascular events and mortality, including
hypertension, in any given population. A few studies have found
that being black could be associated with elevated arterial stiff-
ness, thereby accounting for the high prevalence of hypertension
in these populations. The present study sought to determine
and compare central arterial stiffness using carotid femoral
PWV (cfPWV) in a population of Zambian normotensive (NT)
and hypertensive (HT) participants [both treated (HTC) and
untreated hypertensives (HTN)] between 30 and 65 years of age.
Methods: cfPWVwas measured in 146 participants. AComplior®
analysis device (Version 1.9 Beta 2013; ALAMMedical, France)
was used. Superficial pulses were accessed non-invasively over
the carotid–femoral segment.
Results: The cfPWV values in the HTN participants (n = 23)
were significantly higher than in the NT (n = 64) participants
(11.4 ± 4.2 m/s vs 9.1 ± 3.2 m/s, p = 0.009). In the HTC partici-
pants (n = 59), their cfPWV values (10.4± 5.6 m/s) tended to
approach those in the HTN participants, but with no statistical
differences between them (p > 0.500). Furthermore, the mean
cfPWV found in the NT participants was considerably higher
than any found in previous studies, especially in white-skinned
populations. Carotid femoral PWV did not show significant
age-related increase in all three blood pressure categories (r2 <
0.03, p > 0.100).
Conclusion: These findings show that central elastic arteries of
HT participants, regardless of being on anti-hypertensive ther-
apy or not, were stiffer and therefore less compliant than those
in the NT participants, adding to their burden of hypertension.
Regrettably, the HTC participants showed poor BP control,
inferred from their considerably high cfPWV values that tended
to approach the stiffness values of the untreated group.
BENZATHINE PENICILLINADHERENCE FOR SECOND-
ARY PROPHYLAXIS AMONG PATIENTS AFFECTED
WITH RHEUMATIC HEART DISEASE ATTENDING THE
MULAGO HOSPITAL
Musoke Charles* 1, Mondo Charles Kiiza1, Okello Emmy2,
Zhang Wanzhu2, Kakande Barbara2, Nyakoojo Wilson2, Freers
Juergen3
1 Mulago National Referral Hospital; and Uganda Heart
Institute, Kampala, Uganda;
2Uganda Heart Institute, Kampala, Uganda
3Makerere University, Kampala, Uganda
Introduction: Rheumatic heart disease (RHD) frequently occurs
following recurrent episodes of acute rheumatic fever (ARF).
Benzathine penicillin (benzapen) is the most effective method
for secondary prophylaxis against ARF, whose efficacy largely
depends on adherence to treatment. Various factors determine
adherence to therapy but there are no data regarding current
use of benzapen in patients with RHD attending the Mulago
Hospital. The study aims were (1) to determine the levels of
adherence with benzapen prophylaxis among RHD patients
at the Mulago Hospital, and (2) establish the patient factors