Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

Introduction COVID-19 pandemic is a global public health threat facing mankind. There is no specific antiviral treatment for COVID-19, and many vaccine candidates are currently under clinical trials. This study aimed to understand the perception of social media users regarding a hypothetical COVID-19 vaccine in Nigeria. Methods we conducted a cross-sectional survey among social media users in Nigeria in August 2020 using an online questionnaire. The questionnaire includes sections on the demographic characteristics of the respondents and their perception regarding a hypothetical COVID-19 vaccine. A total of 517 respondents completed and returned the informed consent along with the questionnaire electronically. Data were coded and abstracted into Microsoft Excel spreadsheet and loaded into the STATA 14 software for final analysis. Results the results showed that more than half of the respondents were male 294 (56.9%). Most of the respondents 385 (74.5%) intend to take the COVID-19 vaccine when it becomes available. Among the 132 respondents that would not take the COVID-19 vaccine, the major reason for non-acceptance was unreliability of the clinical trials 49 (37.1%), followed by the belief that their immune system is sufficient to combat the virus 36 (27.3%). We found a significant association between the age of the respondents and the COVID-19 vaccine acceptance (P-value=0.00) as well as geographical location and COVID-19 vaccine acceptance (P-value=0.02). Conclusion it was observed that most of the respondents were willing to take the COVID-19 vaccine. Our findings also reiterate the need to reassure the public the benefits an effective and safe COVID-19 vaccine can reap for public health. There is a need for national health authorities in Nigeria to ensure public trust is earned and all communities, including the marginalized populations, are properly engaged to ensure an optimal COVID-19 vaccine acceptance.

COVID-19 pandemic is a global public health threat facing mankind. There is no specific antiviral treatment for COVID-19, and no vaccine is currently available. This study aims to understand the perception of the public towards hypothetical COVID-19 vaccine in Nigeria. We conducted a cross-sectional survey in August 2020 across the 36 states of Nigeria using an online questionnaire. The questionnaire includes sections on the demographic characteristics of the respondents and their perception regarding hypothetical COVID-19 vaccine. A total of 517 respondents completed and returned the informed consent along with the questionnaire electronically. Data were coded and abstracted into the Microsoft Excel spreadsheet and loaded into the STATA 14 software for final analysis. The results showed that more than half of the respondents were male 294 (56.87%). Most of the respondents (385, 74.47%) intend to take the COVID-19 vaccine when it becomes available. Among the 132 respondents that would not take the COVID-19 vaccine, the major reason for non-acceptance is unreliability of the clinical trials 49 (37.12%), followed by the belief that their immune system is sufficient to combat the virus 36 (27.27%). There are significant association with the respondents age and having reservations toward vaccination [χ2= 19.0389 P-value=0.00] and COVID-19 vaccine acceptance [χ2=24.3316 P-value=0.00]. Furthermore, geographical location and acceptance of the COVID-19 vaccine [χ2=13.7786 P-value=0.02] are significantly associated. Even though the majority of our respondents are willing to take the COVID-19 vaccine, our findings reiterate the need to reassure the public that any vaccine which becomes available is safe and effective.

Objectives:To determine the prevalence and describe factors associated with the use of potentially inappropriate medication (PIM) among older patients.Methods:Cross sectional study of 400 older patients selected systematically at the geriatric centre, University College Hospital, Ibadan between July and September 2016. With the aid of semi-structured questionnaires, information on the socio-demographic characteristics, lifestyle habits, healthcare utilisation and morbidities was obtained. The Beer’s criteria 2015 update was used to identify the PIMs. Predictors of PIMs were determined using multivariate analyses at alpha 0.05.Results:Age was 70.2 (SD=5.9) years and 240 (60%) were females. General prescription pattern showed antihypertensives (34.7%) as the commonest medications used. The point prevalence of PIMs use was 31%. In all, 10 PIMs were used by the respondents. The majority (81.5%) were using one PIM, while (17.7%) used two PIMs and (0.8%) 3 PIMs. NSAIDs (72.6%) were the commonest PIMs identified, followed by the benzodiazepines (24.2%). Respondents had an average of 1.9 morbidities, and mulitmorbidity found in 60.5%. Logistic regression analysis showed self-rated health assessed as better compared with age-mates [OR =1.718 (1.080–2.725)] and being physically active [OR =1.879 (1.026–3.436)] as the most significantly associated with PIMs use.Conclusions:The use of PIMs among older patients in our setting was high with NSAIDs being the most frequently used medications. An interdisciplinary approach, of medication review by pharmacists’, working with physicians may improve prescribing practices among older persons. Therefore, it is necessary to create public health awareness on the use of PIMs among older persons.

COVID-19 is an unprecedented pandemic posing major threat to global public health. In the past decades of years or so, one could have heard of how dangerous it is to be virtually reliant on medicine supply from other countries. Nonetheless, no action was taken because it seemed to many that the global trade system was operational and Nigerians as well as citizens of African countries appear to have sufficient supply of the medications required at quite appealing cost. Currently in 2020, this apprehension has revolved from an imaginary problem to an actual challenge that might have consequences for millions nationwide due to COVID-19 pandemic. Now, African countries can realize that putting all our eggs in one basket was not such a good idea. In Nigeria, over 70% of the prescribed medications are produced from active ingredients (API) primarily sourced from firms in China and India. Access to medicine is an integral part of healthcare systems, uninterrupted access to medicine is much needed and essential for the well-being of the population. We are now approaching the conclusion that it is more reasonable to probably invest a little more to resuscitate a domestic pharmaceutical synthesis and herbal medicine research capacity in Nigeria and across African countries to improve public health.

Background: Access to safe, effective, affordable, and quality medicines is an essential component of the right to health and is also one of the targets in the global development agenda. In this review article, we extensively discuss the challenges and issues surrounding access to medicines in the African region as well as provides recommendations for ensuring medicines security on the continent. Methods: We conducted narrative review with the use of data reported in published literature, reports, and grey literature available in African countries on topics pertaining access to medicines. The authors also snowballed further data to gather information for this review and narrative synthesis was conducted. Results: Africa faces a double burden of infectious and non-communicable diseases and the need for effective universal access to medicines cannot be deemphasized. However, access to medicines on the continent is not without issues and challenges. Some of which are the high burden of infectious diseases and non-infectious diseases, limited pharmaceutical industries and high costs of raw materials, overdependence on countries abroad for medicines, poor supply chain systems, lack of government investment in the pharmaceutical sector, unfavourable manufacturing conditions, limited health workforce, lack of sustainable health financing mechanisms, lack of infrastructures and technical know-how, low investment on research and development, and circulation of fake and counterfeit medicines among others. Conclusion:This review reifies that access to medicines in Africa faces numerous challenges and it emphasizes the urgent need to address these issues as the continent geared towards strengthening its health systems for universal health coverage.

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Background Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. MethodsWe used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990-2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. FindingsIn 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73•7% (68•3 to 77•4) were classified as due to type 1 diabetes. The age-standardised death rate was 0•50 (0•44 to 0•58) per 100 000 population, and 15 900 (97•5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0•13 (0•12 to 0•14) per 100 000 population in the high SDI quintile, 0•60 (0•51 to 0•70) per 100 000 population in the low-middle SDI quintile, and 0•71 (0•60 to 0•86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r²=0•62). From 1990 to 2019, age-standardised death rates decreased globally by 17•0% (-28•4 to -2•9) for all diabetes, and by 21•0% (-33•0 to -5•9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (-13•6% [-28•4 to 3•4]) and for type 1 diabetes (-13•6% [-29•3 to 8•9]). Interpretation Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding Bill & Melinda Gates Foundation.