Background: In Africa hypertension is common and stroke is increasing. Detection, treatment and control of high blood pressure (BP) is limited. BP can be lowered by reducing salt intake. In Africa salt is added to the food by the consumer, as processed food is rare. A population-wide approach with programmes based on health education and promotion is thus possible.

Background Sub-Saharan Africa faces a rapid spread of diabetes mellitus type 2 (DM2) but its potentially specific characteristics are inadequately defined. In this hospital-based study in Kumasi, Ghana, we aimed at characterizing clinical, anthropometric, socio-economic, nutritional and behavioural parameters of DM2 patients and at identifying associated factors. Methods Between August 2007 and June 2008, 1466 individuals were recruited from diabetes and hypertension clinics, outpatients, community, and hospital staff. Fasting plasma glucose (FPG), serum lipids and urinary albumin were measured. Physical examination, anthropometry, and interviews on medical history, socio-economic status (SES), physical activity and nutritional behaviour were performed. Results The majority of the 675 DM2 patients (mean FPG, 8.31 mmol/L) was female (75%) and aged 40-60 years (mean, 55 years). DM2 was known in 97% of patients, almost all were on medication. Many had hypertension (63%) and microalbuminuria (43%); diabetic complications occurred in 20%. Overweight (body mass index > 25 kg/m 2 ), increased body fat (> 20% (male), > 33% (female)), and central adiposity (waist-to-hip ratio > 0.90 (male), > 0.85 (female)) were frequent occurring in 53%, 56%, and 75%, respectively. Triglycerides were increased (≥ 1.695 mmol/L) in 31% and cholesterol (≥ 5.17 mmol/L) in 65%. Illiteracy (46%) was high and SES indicators generally low. Factors independently associated with DM2 included a diabetes family history (adjusted odds ratio (aOR), 3.8; 95% confidence interval (95%CI), 2.6-5.5), abdominal adiposity (aOR, 2.6; 95%CI, 1.8-3.9), increased triglycerides (aOR, 1.8; 95%CI, 1.1-3.0), and also several indicators of low SES. Conclusions In this study from urban Ghana, DM2 affects predominantly obese patients of rather low socio-economic status and frequently is accompanied by hypertension and hyperlipidaemia. Prevention and management need to account for a specific risk profile in this population.

Abstract-Hypertension and stroke are important threats to the health of adults in sub-Saharan Africa. Nevertheless, detection of hypertension is haphazard and stroke prevention targets are currently unattainable. Prevalence, detection, management, and control of hypertension were assessed in 1013 men (nϭ385) and women (nϭ628) In a recent study, the prevalence of hypertension was found to be 28% in North America and 44% in western Europe. 1 Until recently, hypertension was thought to be rare in rural Africa 3-4 ; on the other hand, hypertension and its complications, including stroke, heart failure, and renal failure, have been reported in blacks all over the world. Hypertension is now being widely reported in Africa and is the most common cause of cardiovascular disease on the continent. 5 It is also a major factor in the high mortality of adults in sub-Saharan Africa. 6 In Ghana, hypertensive renal disease is a common complication in both Kumasi and Accra. [7][8] In Ghana, earlier studies revealed a hypertension prevalence of 4.5% among rural dwellers and of 8% to 13% in the town. 9 This was part of an evaluation of the health burden of cardiovascular diseases in Accra and was to form the basis for setting up a hypertension control program. More recently, the prevalence of hypertension in urban Accra was found to be 28.3% (crude) and 27.3% (age-standardized). 10 Hypertension is becoming more common as urbanization increases, and this has been shown in several studies in Africa. 11 A number of studies of urban African populations have shown a positive correlation between blood pressure, age, and gender. The prevalence of hypertension in Accra was much higher in men than in women aged Ͻ40 years but similar above that age. 9 On the other hand, in a recent study prevalence was higher in women than in men. 10 In the developed world, the detection, treatment, and control of hypertension have been characterized by the "rule of halves," 12 although recent evidence suggests that there has been a general improvement. 13 However, in much of sub-Saharan Africa, due to scarce resources and inadequate healthcare provision, detection, treatment, and control are very poor. 9,10,14 The aim of our study was to assess the prevalence, detection, management, and control of hypertension among men and women living in rural and semi-urban villages in the Ashanti Region of Ghana, West Africa. 15 It was part of a community-based study of the prevention of hypertension and stroke in the same region.

Hypertension and stroke are important threats to the health of adults in sub-Saharan Africa. Nevertheless, detection of hypertension is haphazard and stroke prevention targets are currently unattainable. Prevalence, detection, management, and control of hypertension were assessed in 1013 men (nϭ385) and women (nϭ628), both aged 55 [SD 11] years, living in 12 villages in Ashanti, Ghana. Five hundred thirty two lived in semi-urban and 481 in rural villages. The participants underwent measurements of height, weight, and blood pressure (BP) and answered a detailed questionnaire. Hypertension was defined as BP Ն140 and/or Ն90 mm Hg or being on drug therapy. Women were heavier than men. Participants in semi-urban areas were heavier and had higher BP (129/76 [26/14] versus 121/72 [25/13] mm Hg; PϽ0.001 for both) than in rural areas. Prevalence of hypertension was 28.7% overall and comparable in men and women, but higher in semi-urban villages (32.9% [95% CI 28.9 to 37.1] versus 24.1% [20.4 to 28.2]), and increased with age. Detection rate was lower in men than women (13.9% versus 27.3%; Pϭ0.007). Treatment and control rates were low in both groups (7.8% and 4.4% versus 13.6% and 1.7%). Detection, treatment, and control rates were higher in semi-urban (25.7%, 14.3%, and 3.4%) than in rural villages (16.4%, 6.9%, and 1.7%). Hypertension is common in adults in central Ghana, particularly in urban areas. Detection rates are suboptimal in both men and women, especially in rural areas. Adequate treatment of high BP is at a very low level. There is an urgent need for preventive strategies on hypertension control in Ghana.

Background. Equations for estimating glomerular filtration rate (GFR) have not been validated in Sub-Saharan African populations, and data on GFR are few.Methods. GFR by creatinine clearance (Ccr) using 24-hour urine collections and estimated GFR (eGFR) using the four-variable Modification of Diet in Renal Disease (MDRD-4)[creatinine calibrated to isotope dilution mass spectrometry (IDMS) standard], Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Cockcroft–Gault equations were obtained in Ghanaians aged 40–75. The population comprised 1013 inhabitants in 12 villages; 944 provided a serum creatinine and two 24-hour urines. The mean weight was 54.4 kg; mean body mass index was 21.1 kg/m2.Results. Mean GFR by Ccr was 84.1 ml/min/1.73 m2; 86.8% of participants had a GFR of ≥60 ml/min/1.73 m2. Mean MDRD-4 eGFR was 102.3 ml/min/1.73 m2 (difference vs. Ccr, 18.2: 95% CI: 16.8–19.5); when the factor for black race was omitted, the value (mean 84.6 ml/min/1.73 m2) was close to Ccr. Mean CKD-EPI eGFR was 103.1 ml/min/1.73 m2, and 89.4 ml/min/1.73 m2 when the factor for race was omitted. The Cockcroft–Gault equation underestimated GFR compared with Ccr by 9.4 ml/min/1.73 m2 (CI: 8.3–10.6); particularly in older age groups. GFR by Ccr, and eGFR by MDRD-4, CKD-EPI and Cockcroft–Gault showed falls with age: MDRD-4 5.5, Ccr 7.7, CKD-EPI 8.8 and Cockcroft–Gault 11.0 ml/min/1.73 m2/10 years. The percentage of individuals identified with CKD stages 3–5 depended on the method used: MDRD-4 1.6% (7.2 % without factor for black race; CKD-EPI 1.7% (4.7% without factor for black race), Ccr 13.2% and Cockcroft–Gault 21.0%.Conclusions. Mean eGFR by both MDRD-4 and CKD-EPI was considerably higher than GFR by Ccr and Cockcroft–Gault, a difference that may be attributable to leanness. MDRD-4 appeared to underestimate the fall in GFR with age compared with the three other measurements; the fall with CKD-EPI without the adjustment for race was the closest to that of Ccr. An equation tailored specifically to the needs of the lean populations of Africa is urgently needed. For the present, the CKD-EPI equation without the adjustment for black race appears to be the most useful.

The burden of malaria in regions of high endemicity frequently overwhelms hospitals' capacity to provide effective care. A rapid, simple method of identifying children who are at highest risk is vital to reduce mortality among hospitalized children. Multiple regression analysis identified prognostic variables predicting mortality in severely ill children admitted to a Ghanaian teaching hospital. These variables were compared in children with and without malaria. A total of 1492 (90.2%) of 1654 severely ill children referred for assessment had evaluable outcomes. Low Blantyre coma score (BCS), high blood lactate level, and high body mass index were independent predictors of mortality among children with malaria (area under the receiver operating characteristic curve [AUC/ROC], 0.84). In children without malaria, BCS and lactate level also predicted mortality, but the addition of respiratory distress and hematocrit improved the model (AUC/ROC, 0.77). Predictors of mortality in children with malaria differ from those for other severe illnesses and reflect differences in underlying pathophysiological processes.

No abstract

The relationship between BP and BMI is not linear, and is possibly sigmoid, but this may vary between subgroups.