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Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries. We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries. There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79-2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35-2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11-1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001). This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.

ObjectiveIn Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries.SettingOutpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015.ParticipantsPatients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departmentsMain outcome measureWe collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control.ResultsOverall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin–angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01).ConclusionOur study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.

Background Cardiac pacing is a growing activity in Sub-Saharan Africa. There is little data on the characteristics of this interventional treatment in our regions. The goal was to evaluate the results of cardiac pacing in a referral service in sub-Saharan Africa. Methods We carried out a twelve-year retrospective study (from January 1st, 2004 to December 31st, 2015) in the Cardiology Department of Aristide Le Dantec University Hospital. This work included all patients who received definitive cardiac pacing during the study period and followed up in the service. Results In total we included 606 patients. There was a growing trend in activity with a peak in 2015 (17%). The average age was 70.6 ± 12.03 years. Some patients (15.4%) came from the subregion. The patients were mostly of medium socio-economic level (53%); 14% were of low socio-economic level. Patients were symptomatic in 85% of cases (37.4% syncope). The indications were dominated by complete atrioventricular block (81.5%); sinus dysfunction accounted for 1.9% of them. A temporary pacemaker was used in 60% of cases for an average duration of 5.1 ± 6.3 days. Antibiotics, local anesthesia and analgesics were used in all cases. Implanted pacemakers were single chamber in 56% of cases and double chamber in 44% of cases. In 39 patients (6.4%), the pacemaker was a « re-used » one. The atrial leads were most often placed in a lateral position (94.5%). The ventricular ones were predominantly tined (95.7%) and more often located at the apical level. Complications were noted in 24 patients (3.9%), dominated by devices externalizations and infections, which together accounted for 2.7% of cases. The number of people in the cathlab was significantly higher and the duration of the temporary pacemaker was longer for patients who had a complication. There was no significant difference depending on the type of pacemaker used (new or reused). Seven (7) in hospital death cases were reported. Conclusion Cardiac pacing is a growing activity in Dakar.

According to the WHO, 50% of deaths worldwide (40.1% in developing countries) are due to chronic non-communicable diseases (NCDs). Of these chronic NCDs, cardiovascular diseases remain the leading cause of death and disability in developed countries. The Framingham study has shown the importance of hypercholesterolemia as a primary risk factor. In Senegal, the epidemiology of dyslipidemia and obesity are still poorly understood due to the lack of comprehensive studies on their impact on the general population. This motivated this study to look into the key epidemiologic and socio-demographic determinants of these risk factors. It was a cross-sectional descriptive epidemiological survey which included 1037 individuals selected by cluster sampling. Data were collected using a questionnaire following the WHO STEPwise approach. Socio-demographic, health and biomedical variables were collected. P value <0.05 was considered to be statistically significant. The average age was 48 years with a female predominance (M: F of 0.6). The literacy rate was 65.2% and 44.7% of participants were from rural areas. The prevalence of hypercholesterolemia, hyperLDLemia, hypoHDLemia, hypertriglyceridemia and mixed hyperlipidemia were 56%, 22.5%, 12.4%, 7.11% and 1.9% respectively. One in four was obese (BMI> 30kg/m2) and 34.8% had abdominal obesity. The main factors significantly associated with dyslipidemia were obesity, urban dwelling, physical inactivity and a family history of dyslipidemia. The prevalence of dyslipidemia, obesity and other risk factors in the population was high needing immediate care for those affected and implementation of prevention strategies.

The prevalence and characteristics of right heart endocarditis in Africa are not well known. The aim of this study was to describe the epidemiological, clinical and laboratory profiles of patients with right-heart infective endocarditis. This was a 10-year retrospective study conducted in 2 cardiology departments in Dakar, Senegal. All patients who met the diagnosis of right heart infective endocarditis according to the Duke's criteria were included. We studied the epidemiological, clinical as well as their laboratory profiles. There were 10 cases of right-heart infective endocarditis representing 3.04% of cases of infective endocarditis. There was a valvulopathy in 3 patients, an atrial septal defect in 1 patient, parturiency in 2 patients and the presence of a pacemaker in one patient. Anaemia was present in 9 patients whilst leukocytosis in 6 patients. The port of entry was found to be oral in three cases, ENT in one case and urogenital in two cases. Apart from one patient with vegetations in the tricuspid and pulmonary valves, the rest had localized vegetation only at the tricuspid valve. However, blood culture was positive in only three patients. There was a favorable outcome after antibiotic treatment in 4 patients with others having complications; three cases of renal impairment, two cases of heart failure and one case of pulmonary embolism. There was one mortality. Right heart infective endocarditis is rare but associated with potentially fatal complications.

Background: The study of the right ventricle (RV) is of particular interest as it is believed to be involved in several heart diseases. Peripartum cardiomyopathy (PPCM) is characterized by left ventricular systolic dysfunction occurring between the last month of pregnancy and the fifth month postpartum. It is often combined with RV dysfunction, but this has rarely been described in the literature. The main aim of this study was to assess the prevalence of RV dysfunction in a PPCM population. Methods: We conducted a prospective and investigative study at the Cardiac Clinic of the Aristide Le Dantec Teaching Hospital in Dakar, Senegal, between March and June 2013. All patients hospitalized during the study period and meeting the diagnostic criteria for PPCM were included. Results: During the study period, 326 patients were hospitalized in the cardiology department; 19 were diagnosed with PPCM corresponding to a hospital prevalence of 5.8%. All patients had left ventricular dysfunction, with an average ejection fraction of 23.01% [+ or -]9.73% at the Simpson biplane. Based on the tricuspid annular plane systolic excursion (TAPSE), 11 out of the 19 patients (57.9%) had RV systolic dysfunction. Ten patients (52.6%) had an Sa tricuspid wave (speed of the systolic wave to the tricuspid ring in tissue Doppler) below the standard. The average RV area shortening was 23.73% [+ or -]14.16%, with extremes of 7.8% and 53.7%. Fifteen patients (78.9%) had a rate of shortening fraction of the surface area of RV below the standard. When the other parameters were taken into account, 15 patients (78.9%) had at least 3 of the following indexes altered: fractional area change (FAC), Sa tricuspid, TAPSE, and the ratio between the sum of both isovolumic times and the ejection time (TEI index). Conclusion: RV dysfunction is common in PPCM. In view of the prognostic interest on the right ventricle; its evaluation must take into account all of the measurement parameters in order to allow for better detection. Keywords: peripartum cardiomyopathy, right ventricular dysfunction, heart failure, Dakar, Senegal

The aim of this study was to evaluate the frequency of lipid profile requests and the prevalence of dyslipidemia in patients at the biochemistry laboratory of St. Louis University Hospital, as well as their correlation with sex and age. This was a retrospective study reviewing 14,116 laboratory results of patients of both sexes, over a period of six months (January-June 2013) regardless of the indication for the request. The lipid parameters included were: Total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides with normal values defined as follows: Total cholesterol (<2g/l), HDL- cholesterol (>0,40g/l), LDL- cholesterol (<1,30g/l) and Triglycerides (<1,50g/l). The average age of our study population was 55.15 years with a female predorminance (M/F = 0.60). The age group most represented was that between 55-64 years. The frequency of lipid profile request in our sample was 9.41% (or 1,329). The overall prevalence of isolated hypercholesterolemia, hyperLDLaemia, hypoHDLaemia, hypertriglyceridaemia, and mixed hyperlipidemia were respectively 60.91%, 66.27%, 26.58%, 4.57% and 2.75%. Hypercholesterolemia, hyperLDLaemia, hypertriglyceridaemia and mixed hyperlipidaemia were higher in women with respectively 66.22%, 67.98%, 4.58%, 2.89% than in men (52.01%, 62.81%, 4.44% and 2.40% respectively). On the other hand, the prevalence of hypoHDLaemia was higher in males (32.19%) compared to females (23.76%). Hypercholesterolemia correlated significantly with age and sex. Our study showed a relatively low request rate for lipid profile and a high prevalence of dyslipidaemia hence the importance of conducting a major study on the prevalence of dyslipidaemia and associated factors in the Senegalese population.

Les troubles du rythme cardiaque mal tolérés du nouveau-né sont une véritable urgence nécessitant une prise en charge rapide et adéquate. Nous rapportons le cas d'un nouveau-né de 15 jours présentant une tachycardie atriale en défaillance cardiaque aiguë ayant nécessité une cardioversion électrique.

Les tachycardies à QRS large mal tolérées du nourrisson posent le problème de leur diagnostic et de la prise en charge en urgence. Nous rapportons un cas de tachycardie à QRS large chez un nourrisson de 35 jours reçu pour détresse cardio-circulatoire. Le cœur était morphologiquement normal à l’échographie cardiaque Doppler. Un traitement par une dose charge d’Amiodarone n’a pas permis de réduire cette tachycardie. Un retour en rythme sinusal a été obtenu après cardioversion par un défibrillateur externe semi-automatique type Lifeline. Un traitement d’entretien par Amiodarone per os est institué et le patient est en rythme sinusal à 03 mois.

cardiac pacing is the only lifesaving procedure which is effective for major cardiac conduction disorders. In sub-Saharan Africa, few pacemakers are implanted, compared to Western countries. This study aimed to describe the indications for cardiac pacing in four hospitals in Senegal, to evaluate its practical modalities, to identify pacemaker's complications and their predisposing factors and to evaluate the main challenges for cardiac pacing in Senegal. we carried out a retrospective study over four years and eight months, from January 2015 to July 2019 in four hospitals in Dakar (Senegal). All patients who received a single-chamber or double-chamber permanent pacemaker were included. Variables included age, gender, symptoms, comorbidities, ECG results, cardiac pacing indications, implantation data, type of procedure, vein approach, use of temporary stimulation lead, data on the characteristics of the pacemaker and probes, and complications. six-hundred and-twenty (620) permanent cardiac pacemakers were implanted. That is to say an implantation rate of 41 per million population in Senegal. The mean age of the patients was 71±11.77 years. The male gender was in the majority with a sex ratio of 1.19. Eighty-five percent (n=527) of our patients were symptomatic before implantation while 15% (n=93) were asymptomatic. The symptoms were mainly dyspnea in 41% (n=254), dizziness in 32% (n=322) and syncope in 21.3% (n=132). The most found indication was a complete atrioventricular block in 73.7% (n=457), followed by high-degree AVB in 9.2% (n=57). Sinus dysfunction represented 2.4% of indications (n=15). All devices were purchased by patients themselves or their families without government subsidies. Dual-chamber stimulation was the most used mode in 67.1% (n=416) of the patients. Single-chamber stimulation was also used in 32.9% of cases (n=204). The pacemakers were new in 96.1% of cases (n=596) and reused in 3.9% (n=24). The evolution of our patients was generally favorable. Complications occurred in 4.53% of our patients (n=28); mainly leads dislodgements in 1.94% (n=12), infections in 1.29% (n=8), pocket hematomas in 0.65% (n=4), pneumothorax in 0.65% (n=4). implantations in Senegal are most often salvage implantations with a predominance of complete atrioventricular blocks over sinus dysfunction. Complications of cardiac pacing in our study were mostly lead dislodgment and infections. The challenges facing cardiac stimulation in our country remain the lack of a national registry for implantation database and above all, a lack of accessibility to pacemakers which may be improved by the availability and use of reused pacemakers but also by the introduction of subsidies for cardiac electronic devices by African governments.