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

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 34 AFRICA
Methods: In order to bridge the knowledge gap on the burden of
CVD in Tanzania, we initiated a registry of CVD as seen within
the public sector in Dar es Salaam, Tanzania. The Department
of Cardiovascular Medicine at MNH acts as the sole point
within the public sector for definitive diagnosis of patients with
CVD other than uncomplicated essential hypertension. Hence,
by capturing all patients suspected of CVD in the public sector
at the department of Cardiovascular Medicine at Muhimbili
National Hospital and, through the referral system, its catch-
ment area, we are essentially adopting a prospective population-
based study of symptomatic CVD within Dar es Salaam.
Results: While this registry has only recently been launched, we
describe the exciting data emerging from the first six months
of study. At a glance, our study demonstrates a diverse array
of CVD, from the more textbook untreated congenital and
rheumatic heart diseases, to the surge of atherosclerotic cardiac
and vascular disease. Of particular interest as well, however, is
the astonishing number of connective tissue diseases uncovered
through detailed work-up of the presenting CVD patients.
Further to this, we include provisional data of short-term
outcome for all patients, including those who received surgical
or catheter-based interventions.
Conclusions: Already this registry enables us to better depict
the burden of CVD in Tanzania, and tempts a re-look into the
popular assumptions of CVD in Tanzania. Furthermore, it
provides a wake-up call into the principles around pharmaceu-
tical prioritisation for Tanzania with regard to CVD, both in
medications as well as in facilities for invasive therapy.
HEALTH SERVICES FOR CARDIOMETABOLIC DISEAS-
ES AMONG PEOPLE LIVING WITH HIV/AIDS IN LOW-
AND MIDDLE-INCOME COUNTRIES: A PRELIMINARY
SYSTEMATIC REVIEW
Tulloch Nathaniel*, Watkins David1
*Department of Internal Medicine, University of Washington,
Seattle, USA;
1Department of Medicine, University of Cape Town, Cape
Town, South Africa; Department of Medicine, University of
Washington, Seattle, WA, USA
Background and objectives: The roll-out of antiretroviral drug
therapy (ART) has led to a rapid increase in life expectancy
among people living with HIV/AIDS (PLWHA) in low- and
middle-income countries (LMIC), especially in sub-Saharan
Africa. As a result, PLWHA are increasingly at risk for cardio-
metabolic diseases (CMD); yet studies have documented that, in
many LMIC, CMD health services are severely constrained. At
the same time, HIV/AIDS primary care services are relatively
robust in many settings, creating unique opportunities and chal-
lenges around management of CMD among PLWHA. This
study seeks to systematically review the evidence around health
services for CMD among PLWHA in LMIC.
Methods: We developed a systematic review protocol based
on the PRISMA checklist. To characterise and synthesise the
diverse literature in this area, we adapted a conceptual model
for hypertension services (Khatib et al., 2014) to our research
question. We sought to review either quantitative and qualitative
studies on (1) the ‘cascade’ of care for CMD among PLWHA
(i.e. awareness, treatment and control), and (2) barriers and
facilitators to CMD care among PLWHA. The CMD included
in this study were cardiovascular diseases, hypertension, type 2
diabetes, dyslipidaemia and chronic kidney disease. Our protocol
outlines the databases to be searched, the search terms, and the
article-screening process. Our results will be restricted to research
based in LMIC and published in English since the year 1996.
Results: A preliminary application of our search strategy to
Medline yielded 1 313 titles. As a first step to refining our
protocol, we screened publications from the past two years
(150 titles), noting the following general trends. First, only 43
titles were retained for abstract screening. Many studies only
reported the prevalence of metabolic dysfunction from ART
(e.g. lipodystrophy). Only six abstracts had potential relevance
to our research question around elements of the ‘cascade’ of
CMD care. At the same time, these issues were the primary aim
in only three of these studies. These studies found that PLWHA
have poor understanding and low rates of diagnosis of CMD.
Medication availability and low provider knowledge were also
noted as ‘supply side’ barriers. At the same time, medication
adherence clubs, and pedometer-based walking programmes
were notable facilitators of CMD care. Only one study found
that a majority (83%) of PLWHA with hypertension were on
medication.
Conclusions: This preliminary analysis suggests many knowl-
edge gaps around CMD health services among PLWHA. There
do appear to be important differences, compared to the general
population in LMIC. Our next steps will be to refine the search
protocol and terms, and comprehensively screen the literature.
These results can then be used to develop tailored interventions
to improve CMD care among PLWHA.
ANTHROPOMETRIC INDICES: OPTIMAL CUT-OFF
VALUES FOR ABDOMINAL OBESITY IN ADULT NIGE-
RIANS
Umuerri Ejiroghene*, Eze Godson
Delta State University Teaching Hospital, Oghara, Nigeria;
Introduction: Obesity refers to the amount of excessive fat in
the body. The distribution of fat is important as central obesity
has been more linked to adverse cardiovascular risks than has
general obesity. The cut-off values for body mass index (BMI),
waist circumference (WC), waist–hip ratio (WHR) and waist-
to-height ratio (WHtR) have been shown to vary with ethnicity.
This study sets out to determine the optimal cut-off values for
obesity in adult Nigerians using four anthropometric indices.
Methods: This was a cross-sectional population study in Delta
State, Nigeria. Data on weight, height, waist circumference and
hip circumference were obtained using recommended protocols
and BMI, WC, WHR and WHtR were calculated. Assuming
BMI as the standard method for diagnosing obesity, the receiver