IDENTIFYING RISK FACTORS FOR CARDIOVASCULAR DISEASE DURING A MEDICAL MISSION OUTREACH
Folasade O Lawal1, Oluwatosin C Adeyemi2 and Chiamaka Ufondu1
1Victory Drugs, Festac Town, Lagos. firstname.lastname@example.org. 2Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy, University of Lagos. email@example.com
*Corresponding author: firstname.lastname@example.org 08023424425
Cardiovascular diseases (CVD) contribute 17.3million to global mortality annually. With increasing urbanization, sedentary lifestyle, obesity and other worsening social indices, incidence of CVD has continued to rise in Nigeria and other third world countries, ultimately worsening already poor economic and clinical outcomes. Medical missions when properly designed and executed can serve as an important avenue for identifying gaps in patient care and promotion of pharmacist-cognitive services.
The objective of this study was to identify CVD risks in volunteers during a medical mission outreach.
The study was an exploratory study. Volunteers were sampled from respondents at a medical mission at Festac town, Amuwo Odofin, Lagos State. A total of 224 volunteers were interviewed by pharmacists to obtain demographic data and medical history. The weights, height and blood pressure were measured in accordance with JNC7 guidelines. Laboratory tests (Random Blood Sugar or Fasting Blood Sugar and total cholesterol) were conducted by licensed laboratory scientists. Informed consent was taken as decision to participate after the participants were addressed.
The mean weight was 75.4Kg ±12.9) with 42.9% of the total sample obese and 35.7% overweight. Mean BMI between sexes was different (Male 26.9±4.5 and Female 30.92± 4.6) and higher in females (t-test, p< 0.0001). Using the waist circumference measure, 54% of patients had a higher risk of CVD. Both BMI and waist circumference were significantly related to age (F-test, p= 0.001). More than half of the volunteers (57.1%) had systolic blood pressure (SBP) elevated above 140mmHg and 19.6% having diastolic blood pressure elevated above 90mmHg. SBP was significantly higher in males (151.4mmHg±20) than females (140.8mmHg ±20.4) (t-test, p< 0.0001).
Medical missions are an important resource in identifying gaps in the healthcare sector and solutions to such problems can be designed at that level. There is currently a huge gap in patient care in Nigeria and pharmaceutical care can be the platform for bridging the gap in care.
KEY WORDS: Medical missions, Hypertension, Pharmaceutical Care, BMI and Waist Circumference.
TO DOWNLOAD THE FULL TEXT: CLICK HERE
- Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet.380(9859):2224-60. Epub 2012/12/19.
- World Health Organization. (2012). World Health Statistics. 2015 5/03/2015]; Available from: www.who.int/gho/publications/world_health_statistics/2012/en/.
- World Health Organization. (2014). Global status report on noncommunicable diseases 2014.
- Thayer JF, Yamamoto SS, Brosschot JF. (2010). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International journal of cardiology.141(2):122-131.
- Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA.289(19):2560-72. Epub 2003/05/16.
- James PA, Oparil S, Carter BL, et al. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee (jnc 8). JAMA.311(5):507-520.
- National Clinical Guideline Centre. (2011). Aug. Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34. London: National Clinical Guideline Centre.
- Prospective Studies C, Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, et al. (2007). Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet.370(9602):1829-39. Epub 2007/12/07.
- Adebayo AM, Ige OK, Ilesanmi OS, Ogunniyan TB, Ojo T. (2011). Making a case for community screening services: findings from a medical outreach in ibadan, Nigeria. Ann Ib Postgrad Med.9(1):14-8. Epub 2011/06/01.
- Nwankwo KC, Aniebue UU, Aguwa EN, Anarado AN, Agunwah E. (2011). Knowledge attitudes and practices of cervical cancer screening among urban and rural Nigerian women: a call for education and mass screening. Eur J Cancer Care (Engl).20(3):362-7. Epub 2010/03/30.
- Ramsey K, Iliyasu Z, Idoko L. (2007). Fistula Fortnight: innovative partnership brings mass treatment and public awareness towards ending obstetric fistula. Int J Gynaecol Obstet.99 Suppl 1:S130-6. Epub 2007/09/18.
- Akinremi T, Adeniyi A, Olutunde A, Oduniyi A, Ogo C. ( 2014). Need for and relevance of prostate cancer screening in Nigeria. Ecancermedicalscience.8:457.
- Iloh G, Amadi AN, Njoku PU, Ofoedu JN, Awa-Madu J. (2012). The magnitude of abdominal adiposity and atherogenic dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South-eastern Nigeria. Niger J Clin Pract.15(4):462-8. Epub 2012/12/15.
- Akintunde AA, Oladosu Y, Opadijo OG. (2013). Gender specific pattern of left ventricular cardiac adaptation to hypertension and obesity in a tertiary health facility in Nigeria. Afr Health Sci.13(3):595-600. Epub 2013/11/20.
- Akarolo-Anthony SN, Odubore FO, Yilme S, Aragbada O, Odonye G, Hu F, et al. (2013). Pattern of dietary carbohydrate intake among urbanized adult Nigerians. Int J Food Sci Nutr.64(3):292-9.
- World Health Organization. (2003). World Health Organization STEPS Country Report. Geneva, Switzerland. Geneva, Switzerland2015 6th May]; Available from: http://www.who.int/chp/steps/reports/en/.
- Okafor CI, Gezawa ID, Sabir AA, Raimi TH, Enang O. (2014). Obesity, overweight, and underweight among urban Nigerians. Niger J Clin Pract.17(6):743-9. Epub 2014/11/12.
- Abubakari AR, Lauder W, Agyemang C, Jones M, Kirk A, Bhopal RS. (2008). Prevalence and time trends in obesity among adult West African populations: a meta-analysis. Obes Rev.9(4):297-311. Epub 2008/01/09.
- Cohn JN, Ferrari R, Sharpe N. (2000). Cardiac remodeling–concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol.35(3):569-82. Epub 2000/03/15.
- de Simone G, Devereux RB, Roman MJ, Alderman MH, Laragh JH. (1994). Relation of obesity and gender to left ventricular hypertrophy in normotensive and hypertensive adults. Hypertension.23(5):600-6. Epub 1994/05/01.
- Morse SA, Bravo PE, Morse MC, Reisin E. (2005). The heart in obesity-hypertension. Expert Rev Cardiovasc Ther.3(4):647-58. Epub 2005/08/04.
- Iloh G, Amadi AN, Nwankwo BO, Ugwu VC. (2011). Obesity in adult Nigerians: a study of its pattern and common primary co-morbidities in a rural Mission General Hospital in Imo state,South-Eastern Nigeria. Niger J Clin Pract.14(2):212-8. Epub 2011/08/24.
- Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. (2007). Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care.30(1):162-72. Epub 2006/12/29.
- Gaede P, Lund-Andersen H, Parving HH, Pedersen O. (2008). Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med.358(6):580-91. Epub 2008/02/08.
- American Diabetes A. (2015). (8) Cardiovascular disease and risk management. Diabetes Care.38 Suppl:S49-57. Epub 2014/12/30.
- Fasanmade OA, Odeniyi IA, Amira CO, Okubadejo NU. (2013). Association of body mass index and abdominal adiposity with atherogenic lipid profile in Nigerians with type 2 diabetes and/or hypertension. Niger Med J.54(6):402-7. Epub 2014/03/26.
- Okosun IS, Cooper RS, Rotimi CN, Osotimehin B, Forrester T. (1998). Association of waist circumference with risk of hypertension and type 2 diabetes in Nigerians, Jamaicans, and African-Americans. Diabetes Care.21(11):1836-42. Epub 1998/11/05.
- Kerenyi Z, Stella P, Bosnyak Z, Tabak AG, Tamas G. (1999). Association between central adiposity and multimetabolic syndrome in a special cohort of women with prior gestational diabetes. Diabetes Care.22(5):876-7. Epub 1999/05/20.
- Santschi V, Chiolero A, Paradis G, Colosimo AL, Burnand B. (2012). Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Care.35(12):2706-17. Epub 2012/11/23.
- Eison H, Phillips RA, Ardeljan M, Krakoff LR. (1990). Differences in ambulatory blood pressure between men and women with mild hypertension. J Hum Hypertens.4(4):400-4. Epub 1990/08/01.
- Gleim GW, Stachenfeld NS, Coplan NL, Nicholas JA. (1991). Gender differences in the systolic blood pressure response to exercise. Am Heart J.121(2 Pt 1):524-30. Epub 1991/02/01.
- Houehanou YC, Lacroix P, Mizehoun GC, Preux PM, Marin B, Houinato DS. (2015). Magnitude of cardiovascular risk factors in rural and urban areas in benin: findings from a nationwide steps survey. PLoS One.10(5):e0126441. Epub 2015/05/07.
- Mathenge W, Foster A, Kuper H. (2010). Urbanization, ethnicity and cardiovascular risk in a population in transition in Nakuru, Kenya: a population-based survey. BMC Public Health.10:569. Epub 2010/09/24.
- Morgado M, Rolo S, Castelo-Branco M. (2011). Pharmacist intervention program to enhance hypertension control: a randomised controlled trial. Int J Clin Pharm.33(1):132-40. Epub 2011/03/03.
- Morgado MP, Morgado SR, Mendes LC, Pereira LJ, Castelo-Branco M. (2011). Pharmacist interventions to enhance blood pressure control and adherence to antihypertensive therapy: Review and meta-analysis. Am J Health Syst Pharm.68(3):241-53. Epub 2011/01/25.
- Fischer MA, Choudhry NK, Bykov K, Brill G, Bopp G, Wurst AM, et al. (2014). Pharmacy-based interventions to reduce primary medication nonadherence to cardiovascular medications. Med Care.52(12):1050-4. Epub 2014/10/17.
- Carter BL, Doucette WR, Franciscus CL, Ardery G, Kluesner KM, Chrischilles EA. (2010). Deterioration of blood pressure control after discontinuation of a physician-pharmacist collaborative intervention. Pharmacotherapy.30(3):228-35. Epub 2010/02/26.
- Tremblay M, Comtois D, O’Loughlin J. (2013). Pharmacists’ smoking cessation counseling practices: a comparison between 2005 and 2010. Nicotine Tob Res.15(12):2114-9. Epub 2013/08/15.
- Saba M, Diep J, Saini B, Dhippayom T. (2014). Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. J Clin Pharm Ther.39(3):240-7. Epub 2014/04/23.
- Marin Armero A, Calleja Hernandez MA, Perez-Vicente S, Martinez-Martinez F. (2015). Pharmaceutical care in smoking cessation. Patient Prefer Adherence.9:209-15.
- Aguwa CN, Ukwe CV, Ekwunife OI. (2008). Effect of pharmaceutical care programme on blood pressure and quality of life in a Nigerian pharmacy. Pharm World Sci.30(1):107-10. Epub 2007/08/19.
- Lenz TL, Monaghan MS. (2008). Lifestyle modifications for patients with hypertension. J Am Pharm Assoc (2003).48(4):e92-9; quiz e100-2. Epub 2008/07/26.
- Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. (2013). Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA.310(9):959-68. Epub 2013/09/05.
- Pande S, Hiller JE, Nkansah N, Bero L. (2013). The effect of pharmacist-provided non-dispensing services on patient outcomes, health service utilisation and costs in low- and middle-income countries. Cochrane Database Syst Rev.2:CD010398. Epub 2013/03/02.
- Wal P, Wal A, Bhandari A, Pandey U, Rai AK. (2013). Pharmacist involvement in the patient care improves outcome in hypertension patients. J Res Pharm Pract.2(3):123-9. Epub 2014/07/06.
- Amariles P, Sabater-Hernandez D, Garcia-Jimenez E, Rodriguez-Chamorro MA, Prats-Mas R, Marin-Magan F, et al. (2012). Effectiveness of Dader Method for pharmaceutical care on control of blood pressure and total cholesterol in outpatients with cardiovascular disease or cardiovascular risk: EMDADER-CV randomized controlled trial. J Manag Care Pharm.18(4):311-23. Epub 2012/05/03.