screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidencebased, inexpensive BP-lowering agents.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a ‘roadmap’ of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa.Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseases (NCD), (4) decentralise technical expertise and technology for diagnosing and managing ARF and RHD (including ultrasound of the heart), (5) establish national and regional centres of excellence for essential cardiac surgery for the treatment of affected patients and training of cardiovascular practitioners of the future, (6) initiate national multi-sectoral RHD programmes within NCD control programmes of affected countries, and (7) foster international partnerships with multinational organsations for resource mobilisation, monitoring and evaluation of the programme to end RHD in Africa.This Addis Ababa communiqué has since been endorsed by African Union heads of state, and plans are underway to implement the roadmap in order to end ARF and RHD in Africa in our lifetime.

BackgroundPhysical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer. Globally, research has shown that modifying four commonly shared risky behaviours, including poor nutrition, tobacco use, harmful use of alcohol, and physical inactivity, can reduce occurrence of non-communicable diseases (NCDs). Risk factor surveillance through population-based periodic surveys, has been identified as an effective strategy to inform public health interventions in NCD control. The stepwise approach to surveillance (STEPS) survey is one such initiative, and Kenya carried out its first survey in 2015. This study sought to describe the physical inactivity risk factors from the findings of the Kenya STEPS survey.MethodsThis study employed countrywide representative survey administered between April and June 2015. A three stage cluster sampling design was used to select clusters, households and eligible individuals. All adults between 18 and 69 years in selected households were eligible. Data on demographic, behavioural, and biochemical characteristics were collected. Prevalence of physical inactivity was computed. Logistic regression used to explore factors associated with physical inactivity.ResultsA total of 4500 individuals consented to participate from eligible 6000 households. The mean age was 40.5 (39.9–41.1) years, with 51.3% of the respondents being female. Overall 346 (7.7%) of respondents were classified as physically inactive. Physical inactivity was associated with female gender, middle age (30–49 years), and increasing level of education, increasing wealth index and low levels of High Density Lipoproteins (HDL).ConclusionA modest prevalence of physical inactivity slightly higher than in neighbouring countries was found in this study. Gender, age, education level and wealth index are evident areas that predict physical inactivity which can be focused on to develop programs that would work towards reducing physical inactivity among adults in Kenya.

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Objectives: To determine the adequacy of blood pressure (BP) control and level of adherence to pharmacotherapy in hypertensive outpatients. Design: Cross-sectional study. Setting: General medical outpatient clinics at a tertiary referral hospital, Kenyatta National Hospital. Subjects: Hypertensive with at least one documented renewal of prescription. Main outcome measure: Adequacy of BP control and level of adherence by the Hill-Bone score. Results: Of 783 patients screened over a six month period, 575 (73%) met the inclusion criteria and 264 were randomly recruited; 67% were female; mean age was 57.3 years; mean duration of hypertension was 6.75 years (range six months to 31 years);21.6% had normal BMI. Knowledge of lifestyle measures for BP control was weight loss 50%, exercise 54% and salt restriction 80%. Number of antihypertensives prescribed were 35.2% two drugs, 36.6% three drugs and 14.9% on four or more drugs; with drugs class being thiazide diuretics 64.1%, B-blockers 55.7%, calcium channel blockers 55.3% and angiotensin system inhibitors at 50.4%. Sixty eight (26%) had adequate BP control and 114 (58.5%) of those with inadequate BP control had BP of > 160/l00mmHg. Eighty four (31.8%) of the patients were fully adherent to antihypertensive therapy. Non adherence was not significantly associated with any socio-demographic factors. Poor BP control was significantly associated with non adherence (p=0.006, r 2 =0.54 SBP, 0.63 DBP), obesity (p=0.03), and increasing number of medications (p=0.012 DBP and 0.038 SBP);other factors included obesity, suboptimal dosing and suboptimal therapeutic combinations. Conclusion: We document poor BP control in 75% of our treated hypertensive patients and this is largely due to non adherence, with other associated factors being obesity, suboptimal drug combinations and doses.