Abstract
Background
Visual impairment (VI) and determinants of poor cardiovascular health are very common in Sub-Saharan Africa. However, we do not know whether these determinants are associated with ...VI among older adults in this region. This study aimed at investigating the association between the determinants of poor cardiovascular health and near VI among older adults living in Congo.
Methods
Participants were Congolese adults aged 65 or older included in Epidemiology of Dementia in Central Africa—Follow-up population-based cohort. Near VI was defined as visual acuity less than 20/40 measured at 30 cm. Associations between determinants of poor cardiovascular health collected at baseline and near visual acuity measured at first follow-up were investigated using multivariable logistic regression models.
Results
Among the 549 participants included, 378 (68.8%; 95% confidence interval CI: 64.9%–72.7%) had near VI. Of the determinants of poor cardiovascular health explored, we found that having high body mass index of at least 25 kg/m2 (odds ratio OR = 2.15; 95% CI: 1.25–3.68), diabetes (OR = 2.12; 95% CI: 1.06–4.25) and hypertension (OR = 1.65; 95% CI: 1.02–2.64) were independently associated with near VI.
Conclusions
Several determinants of poor cardiovascular health were associated with near VI in this population. This study suggests that promoting good cardiovascular health could represent a target for VI prevention among older adults.
Abstract
Background
With global ageing, multimorbidity becomes a priority for global health research. Multimorbidity prevalence increases with age and is associated with poorer health outcomes. As ...people live longer, chronic conditions, including dementia, are rising in low‐ and middle‐income countries (LMIC) but the relationship between multimorbidity and dementia is not well studied despite its importance for dementia prevention. The aim of this study is to investigate the association between multimorbidity and dementia among older people in Central African countries.
Methods
A multicentre population‐based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites. Participants aged ≥65 years old were interviewed using a structured questionnaire (sociodemographic data, clinical history) and underwent a physical examination. Multimorbidity (ie. the presence of two or more chronic diseases in the same individual) was ascertained as a count of up to 12 mental, cognitive and physical health conditions. Conditions were either collected through self‐report or assessed during the physical exam. DSM‐IV criteria were required for dementia diagnoses. The association of multimorbidity with dementia was assessed using logistic regression models.
Results
At baseline, 2002 participants were included across the two countries (mean age 73.3 ± 6.7 years, sex‐ratio M/F = 0.62) and 135 were diagnosed with dementia. Overall 55.3% of the participants had 2 or more chronic diseases, with hypertension, depression, heart disease, pulmonary conditions, and visual impairment as the most common comorbidities. A higher prevalence of multimorbidity was found in Congo than in Central African Republic. Dementia was significantly associated with the presence of multimorbidity (OR=1.45, 95%CI 1.01‐2.00), however the effect disappeared after adjustment on age, sex and study site. There was a non‐significant trend of greater odds of dementia with an increasing number of comorbidities.
Conclusions
The results support a high prevalence of multimorbidity among these older populations, especially among people with dementia. However, odds of dementia seemed to not be significantly impacted by multimorbidity in this context. Due to its high prevalence and low access to healthcare, this evidence remains of importance for medical care of comorbidities in older populations of sub‐Saharan Africa.
Background
With global ageing, multimorbidity becomes a priority for global health research. Multimorbidity prevalence increases with age and is associated with poorer health outcomes. As people live ...longer, chronic conditions, including dementia, are rising in low‐ and middle‐income countries (LMIC) but the relationship between multimorbidity and dementia is not well studied despite its importance for dementia prevention. The aim of this study is to investigate the association between multimorbidity and dementia among older people in Central African countries.
Methods
A multicentre population‐based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites. Participants aged ≥65 years old were interviewed using a structured questionnaire (sociodemographic data, clinical history) and underwent a physical examination. Multimorbidity (ie. the presence of two or more chronic diseases in the same individual) was ascertained as a count of up to 12 mental, cognitive and physical health conditions. Conditions were either collected through self‐report or assessed during the physical exam. DSM‐IV criteria were required for dementia diagnoses. The association of multimorbidity with dementia was assessed using logistic regression models.
Results
At baseline, 2002 participants were included across the two countries (mean age 73.3 ± 6.7 years, sex‐ratio M/F = 0.62) and 135 were diagnosed with dementia. Overall 55.3% of the participants had 2 or more chronic diseases, with hypertension, depression, heart disease, pulmonary conditions, and visual impairment as the most common comorbidities. A higher prevalence of multimorbidity was found in Congo than in Central African Republic. Dementia was significantly associated with the presence of multimorbidity (OR=1.45, 95%CI 1.01‐2.00), however the effect disappeared after adjustment on age, sex and study site. There was a non‐significant trend of greater odds of dementia with an increasing number of comorbidities.
Conclusions
The results support a high prevalence of multimorbidity among these older populations, especially among people with dementia. However, odds of dementia seemed to not be significantly impacted by multimorbidity in this context. Due to its high prevalence and low access to healthcare, this evidence remains of importance for medical care of comorbidities in older populations of sub‐Saharan Africa.
Chumlea's formulas are a way of predicting height from knee height (KHt), including among individuals >60 y of age who cannot stand upright. However, the formulas were developed with white and ...African American people and have not yet been validated in native Africans >60 y of age. The aims of the study were to assess Chumlea's formulas in older people in central Africa and to propose a new validated formula for the same population.
Height (MHt) and KHt were measured in a population of individuals >65 y of age from the Republic of Congo and the central African Republic. Predicted height (PHt) was calculated using Chumlea's formulas for the American black population (CBP) and for whites (CC). The percentages of accurate predictions (±5 cm) were compared between MHt and PHt. A new formula was estimated after randomization in a derivation sample (n = 877) and assessed for accuracy in a validation sample (n = 877).
The study included 1754 individuals. Prediction was accurate (±5 cm) in 66.8% and 63.2% of CBP and CC, respectively. Overestimation was as high as 24.1% and 29%, respectively. Because an overestimation is unacceptable in clinical practice and population surveys, a new formula was proposed:
height (cm) = 72.75 + (1.86 × KHt cm) – (0.13 × age y) + 3.41 × sex (0: women; 1: men).
This new formula significantly increases accuracy (71.3%) and decreases overestimation (14.7%). The nutritional status based on body mass index did not differ with the MHt and the PHt by the new formula.
Chumlea's formulas provided a poor estimate of height in this population sample. The proposed formula more accurately estimates height in older native Africans. This formula should be tested in other sub-Saharan African countries to extend its use in clinical practice and in future studies.
•Chumlea's formulas provided a poor estimate of height in older people of central Africa.•A new formula more accurately estimates height.•Nutritional status did not differ with the measured height and predicted height by the new formula.
•We assess the perception of health professionals in Africa regarding the stigmatization of PWE.•PWE are stigmatized especially in the community setting, this stigmatization include isolation, ...celibacy, unemployment and divorce.•Measures against stigmatization must be undertaken, to improve the quality of epilepsy management.•Awareness campaigns are essential to reduce stigma and improve the quality of life of PWE.
Epilepsy is a major public health problem in developing countries where eighty percent (80%) of people with epilepsy (PWE) live. Stigma has psychological consequences as well as serious repercussions on patients’ quality of life. This study assesses the perception of health professionals in Africa regarding the stigmatization of PWE.
This is a multicenter descriptive, cross-sectional study, from 1st August 2020 to 1st September 2021. Medical practitioners from African countries involved in the management of epilepsy and who agreed to fill out forms were included in the study. Sampling was nonrandom and based on respondent choice. The data were analyzed using the EPI INFO 7 software.
A total of two hundred and twenty-nine (229) health workers from twenty-six (26) African countries participated in this survey. 24.89% of the respondents were specialists and 46.72% were neurologists. Ninety-one percent (91%) of practitioners felt that PWE were stigmatised. The main forms of stigma were isolation (68.56%), celibacy (60.70%), unemployment (53.28%), divorce (44.54%) and exclusion (37.99%)%). Community, school and family were recognized as the main places of stigmatization. The fight against this stigma was carried out mainly in hospitals and in isolation in 58.4% and 55.8% of cases, respectively. Only 0.4% of practitioners opted for mass awareness.
PWE are victims of various forms of stigmatization, particularly in community settings. Measures aimed at raising awareness of the public are essential to reduce this stigma and improve patients’ quality of life.
Background
The worldwide population is ageing and the proportion of elderly aged 60 and over is expected to dramatically rise in Low and Middle Income Countries (LMIC). The epidemic of dementia will ...not spare those countries, where the largest increases in numbers of people affected are estimated. Besides, dementia is still understudied in sub-Saharan Africa (SSA) compared to other regions. This paper describes the protocol for the ‘Epidemiology of Dementia in Central Africa’ population-based study, which aims at estimating the prevalence of dementia in two countries of Central Africa and investigating possible risk factors.
Methods/Design
A multicenter population-based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites in each country. Around 2000 participants aged ≥65 years old were interviewed in total using the Community Screening Interview for Dementia (CSI-D), the GMS-AGECAT and the CERAD’s 10-word list. Elderly with low performance to the cognitive part of the CSI-D (COGSCORE ≤ 24.5) were then clinically assessed by neurologists and underwent further psychometrical tests. DSM-IV and NINCDS-ADRDA criteria were required for dementia and Alzheimer’s disease (AD) diagnoses respectively. The algorithmic 10/66 dementia diagnosis was also determined. Petersen’s criteria were required for the diagnosis of Mild Cognitive Impairment. Sociodemographic, and environmental factors including vascular, nutritional, biological, psychosocial and lifestyle factors were collected in each setting in order to investigate factors associated with dementia. Blood sampling was realized to investigate genetic variations that could modify the risk of dementia.
Discussion
For now, no large epidemiological study has been undertaken to compare the prevalence of dementia in both rural and urban areas within SSA countries. This programme will provide further evidence regarding the prevalence of dementia in SSA, and also the possible rural/urban disparities existing with associated factors. Furthermore, the genetics of AD in those populations will be addressed.
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