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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S17
AFRICA
Challenges in the management of infective endocarditis in a developing country
Oukemi Ige*, Fatima Baba
#
, Christopher Yilgwan* and Fidelia Bode-Thomas*
*University of Jos, Jos, Nigeria.
#
Jos University Teaching Hospital, Jos, Nigeria
Introduction:
The diagnosis of infective endocarditis (IE) in Nigeria is still challenging as health care expenditure is mostly out-of-pocket. Also, the high rate
of antibiotic use before presentation increases the rate of culture negative infections, thereby affecting outcomes. We evaluated the outcomes of children
diagnosed with IE at a tertiary hospital in Jos, Nigeria.
Methods:
A prospective study in which children with a diagnosis of definite or possible IE were recruited over a period of 18 months using the modified
Duke’s criteria. Demographic, laboratory and echocardiographic findings were documented. Data were analysed using STATA 14.0.
Results:
A total of 31 children were recruited with 16 (51.6%) males; mean age of 10.9 years. Fourteen (45.2%) of the 31 children had definite IE. RHD was
the most common underlying cardiac disease followed by congenital heart disease (CHD). Only 1 child had no underlying heart disease whilst another had
dilated cardiomyopathy. The mean duration of illness before diagnosis was 41.7 days; range of 4 - 180 days. Previous antibiotic use was present in 18 (58.1%)
children, vegetations in 12 (38.7%) while cultures were positive in 6 (19.4%) children. Eighteen children (58.1%) died. Mortality was more frequent among
children who were older [11.5 years (95% CI 8.2, 14.8 years) vs. 9.2 years (95% CI 4.4, 13.9 years), p=0.4], had a lower fractional shortening [26.1% (95% CI 19.0,
33.1%) vs. 34.1% (95% CI 19.5, 43.8%), p=0.21 ] and a longer mean duration of illness [50.1 days (95% CI 19.0, 81.2 days) vs. 21.1 days (11.2, 47.1 days), p=0.34].
These differences were, however, not statistically significant.
Conclusion:
The high rate of previous antibiotic use and low rate of culture positive cases contribute to challenges in the management of IE in Nigeria. A
high index of suspicion would promote earlier diagnosis and treatment.
Reproductive health services and cardiovascular health: The RESCUE RHD project pilot phase (small grant)
Keila Jamal
Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
Introduction:
Results from the largest rheumatic heart disease registry in sub-Saharan Africa (REMEDY), reported considerable more women in their
reproductive age as men. Recognising that RHD disproportionately affects females, and that it is a significant cause of morbidity and maternal mortality,
the UN has recently recommended its inclusion in maternal and child health programmes. Our project is a step towards guaranteeing better access to
reproductive health services for women living with CVD (including RHD) in Mozambique.
Methods:
The project was aimed at improving knowledge of common CVD (including RHD) and improving access to care for women of child-bearing age.
This phase ran for a period of 6 months, 2018 – 2019, and comprised 3 main activities: (1.) starting up joint obstetric clinic integration with 2 referral hospitals,
(2.) holding 3 workshops with gynaecologists in Maputo City and (3.) conducting 3 focus group discussions with CVD patients in order to identify potential
peer supporters.
Results:
The joint clinic currently has a 5-member team: 1 cardiologist, 2 gynaecologists, 1 general practitioner and 1 nurse. A registry of women of
reproductive age with CVD was created and submitted for approval by the ethics committee; 15 patients have been registered. On average, training
workshops contained 23 participants who indicated overall satisfaction with the knowledge gained. We identified 6 patients to become peer supporters (5
females). These patients have good communication skills, are willing to work with their peers and have received training. From focus group discussions, 3
major themes were identified: family planning, pregnancy and adherence to treatment.
Conclusion:
Pilot activities to implement health education showed an improvement in knowledge and identified peer-supporters within the group of RHD
patients. Workshops which facilitate interaction between clinicians and patients have been used to build a sense of team and prepare the peer educators in
relevant themes, as raised by patients.
Fibrosis and autonomic dysfunction in Africans: The SABPA prospective study
Esmé Jansen van Vuren, Annemarie Wentzel, Leoné Malan and Nicolaas Malan
North-West University, Mahikeng, Vanderbijlpark, South Africa
Introduction:
Fibrosis increases the burden on the heart through mechanisms related to ischaemic heart disease risk. Compensatory blood pressure,
increased to alleviate perfusion deficits, may facilitate sympathetic hyperactivity, attenuate heart-rate-variability (HRV) and enhance fibrosis. The aim of this
study was therefore to determine whether fibrosis, as indicated by the inflammation-coagulation ratio (C-reactive protein:fibrinogen) relates to time-domain
HRV parameters.
Methods:
The Sympathetic Activity and ambulatory Blood Pressure in Africans (SABPA) prospective cohort study was conducted on African and Caucasian
teachers (n=359), aged 20 - 65 years, over a 3-year period. Ambulatory blood pressure and ECG measures were used to determine 24-hour HRV time domain
measures (standard deviation of intervals/SDNN, heart rate triangular index/HRVti which provides an estimate of the overall HRV; and the root mean square of
successive differences between adjacent RR intervals/RMSSD). Both SDNN and RMSSD reflect vagus nerve-mediated autonomic control of the heart. Fasting
blood samples were obtained to determine C-reactive protein (CRP) and fibrinogen levels.
Results:
Africans revealed a higher CRP:fibrinogen ratio (p<0.001) and a lower HRVti (p<0.001) compared to Caucasians. In Africans, HRVti was inversely
associated with CRP:fibrinogen (ß= -0.13, p=0.04). Furthermore, CRP:fibrinogen increased the likelihood for SDNN <100ms [R2 0.33, OR 5.00 (95% CI 1.01,
24.79); p=0.05] in Africans.
Conclusion:
Fibrosis facilitated autonomic nervous system dysfunction and may increase the risk for depressed HRV and ischaemic heart disease
in Africans.