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Hypertension is a leading contributor to mortality in low‐middle income countries including Haiti, yet only 13% achieve blood pressure (BP) control. We evaluated the effectiveness of a community‐based hypertension management program delivered by community health workers (CHWs) and physicians among 100 adults with uncontrolled hypertension from the Haiti Cardiovascular Disease Cohort. The 12‐month intervention included: community follow‐up visits with CHWs (1 month if BP uncontrolled ≥140/90, 3 months otherwise) for BP measurement, lifestyle counseling, medication delivery, and dose adjustments. Primary outcome was mean change in systolic BP from enrollment to 12 months. Secondary outcomes were mean change in diastolic BP, BP control, acceptability, feasibility, and adverse events. We compared outcomes to 100 age, sex, and baseline BP matched controls with standard of care: clinic follow‐up visits with physicians every 3 months. We also conducted qualitative interviews with participants and providers. Among 200 adults, median age was 59 years, 59% were female. Baseline mean BP was 154/89 mmHg intervention versus 153/88 mmHg control. At 12 months, the difference in SBP change between groups was −12.8 mmHg (95%CI −6.9, −18.7) and for DBP −7.1 mmHg (95%CI −3.3, −11.0). BP control increased from 0% to 58.1% in intervention, and 28.4% in control group. Four participants reported mild adverse events. In mixed methods analysis, we found community‐based delivery addressed multiple participant barriers to care, and task‐shifting with strong teamwork enhanced medication adherence. Community‐based hypertension management using task‐shifting with CHWs and community‐based care was acceptable, and effective in reducing SBP, DBP, and increasing BP control. [ABSTRACT FROM AUTHOR]

Objective To describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals. Methods Adults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation. Findings In total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients' mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi ortuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired. Conclusion In emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Decrire les caracteristiques et les principales affections des adultes qui ont recours aux soins d'urgence dans deux hopitaux cambodgiens provinciaux de reference. Methodes Les adultes ages de plus de 18 ans qui se sont presentes sans rendez-vous a deux hopitaux publics de reference, ont ete inscrits a une etude observationnelle. Les donnees cliniques et demographiques ont ete recueillies et les facteurs associes a l'hospitalisation ont ete identifies. Les patients ont ete suivis 48 heures et 14 jours apres leur presentation. Resultats Au total, 1295 presentations a Lhopital ont ete documentees. Nous avons pu suivre 85% (1098) des patients 48 heures et 77% (993) 14 jours apres leur presentation. L'age moyen des patients etait de 42 ans et 64% (823) des patients etaient des femmes. La plupart des patients etaient arrives en moto (722), en taxi ou en tuk-tuk (312). Les principales affections communes etaient en majorite des douleurs abdominales (36%; 468), des problemes respiratoires (15%; 196) et des maux de tete (13%; 174). Parmi les 1050 patients dont les signes vitaux ont ete enregistres, 280 avaient des valeurs anormales, hormis la temperature, lors de leur arrivee. Les tests diagnostiques realises ont ete enregistres pour 539 patients: 1,2% (15) des patients avait beneficie d'une electrocardiographie et 14% (175) des patients avaient beneficie de l'imagerie diagnostique. Par la suite, 783 (60%) patients ont ete hospitalises et 166 d'entre eux ont subi une operation chirurgicale. Les indicateurs significatifs d'hospitalisation comprenaient l'apparition des symptomes dans les 3 jours precedant la presentation, des signes vitaux anormauxet la fievre. A Tissue du suivi des 14 jours, 3,9% (39/993) des patients etaient decedes et 19% (192/993) des patients presentaient des capacites fonctionnelles diminuees. Conclusion Dans les hospitalisations d'urgence dans les deux hopitaux publics au Cambodge, il y a un rapport hospitalisation-deces eleve et une application limitee des techniques de diagnostic. Nous avons identifie des moyens pour ameliorer les procedures, y compris Ia meilleure documentation des signes vitaux et l'utilisation accrue des techniques de diagnostic. Objetivo Describir las caracteristicas y quejas principales de los adultos que solicitan atencion de emergencia en dos hospitals provinciales de remision de Camboya. Metodos Se inscribio a adultos mayores de 18 anos que acudieron sin cita previa a dos hospitales publicos de remision en un estudio observacional. Se recogieron datos clinicos y demograficos y se identificaron los factores relacionados con el ingreso hospitalario. Se realizo un seguimiento a los pacientes durante 48 horas y 14 dias despues de la visita hospitalaria. Resultados En total, se documentaron 1295 visitas hospitalarias. Se logro realizar un seguimiento del 85 % (1098) y del 77 % (993) de los pacientes a las 48 horas y a los 14 dias, respectivamente. La edad media de los pacientes fue de 42 anos y el 54 % (823) eran mujeres. La mayoria acudio en motocicleta (722), taxi o tuk-tuk (312). Las quejas principales mas comunes fueron dolor abdominal (36 %; 458), problemas respiratorios (15 %; 196) y cefalea (13 %; 174). De los 1050 pacientes con registro de constantes vitales, 280 presentaron valores anomalos, a excepcion de la temperatura corporal, a su llegada. Se registraron las pruebas diagnosticas realizadas en 539 pacientes: se realizo una electrocardiografia al 1,2% (15) e imagenes diagnosticas al 14% (175) de los pacientes. Posteriormente, 783 (60 %) de los pacientes fueron ingresados, de los cuales 166 se sometieron a cirugia. Los predictores significativos para el ingreso incluyeron Ia aparicion de los sintomas 3 dias antes de Ia visita hospitalaria, constantes vitales anomalas yfiebre. Antes de finalizar el seguimiento de 14 dias, el 3,9 % (39/993) de los pacientes habia fallecido y el 19 % (192/993) seguia presentando discapacidades funcionales. Conclusion Las hospitalizaciones de emergencia de dos hospitales publicos de Camboya presentan una elevada relacion entre ingreso y defuncion, asi como un uso limitado de Ias tecnicas de diagnostico. Se identificaron formas de mejorar los procedimientos, como una mejor documentacion de las constantes vitales y un mayor uso de Ias tecnicas de diagnostico., Introduction Emergency medicine is a neglected component of health-care systems in most low- and middle-income countries. Nearly half of deaths and one third of disability adjusted life-years lost in these [...]

Background: Cardiovascular disease disproportionately affects persons living in low- and middle-income countries and heart failure (HF) is thought to be a leading cause. Population-based studies characterizing the epidemiology of HF in these settings are lacking. We describe the age-standardized prevalence, survival, subtypes, risk factors, and 1-year mortality of HF in the population-based Haiti Cardiovascular Disease Cohort.Methods: Participants were recruited using multistage cluster-area random sampling in Port-au-Prince, Haiti. A total of 2981 completed standardized history and exam, laboratory measures, and cardiac imaging. Clinical HF was defined by Framingham criteria. Kaplan-Meier and Cox proportional hazard regression assessed mortality among participants with and without HF; logistic regression identified associated factors.Results: Among all participants, the median age was 40 years (interquartile range, 27-55), and 58.2% were female. Median follow-up was 15.4 months (interquartile range, 9-22). The age-standardized HF prevalence was 3.2% (93/2981 [95% CI, 2.6-3.9]). The average age of participants with HF was 57 years (interquartile range, 45-65), and 67.7% were female. The first significant increase in HF prevalence occurred between 30 to 39 and 40 to 49 years (1.1% versus 3.7%, P=0.003). HF with preserved ejection fraction was the most common HF subtype (71.0%). Age (adjusted odds ratio, 1.36 [1.12-1.66] per 10-year increase), hypertension (2.14 [1.26-3.66]), obesity (3.35 [95% CI, 1.99-5.62]), poverty (2.10 [1.18-3.72]), and renal dysfunction (5.42 [2.94-9.98]) were associated with HF. One-year HF mortality was 6.6% versus 0.8% (hazard ratio, 7.7 [95% CI, 2.9-20.6]; P<0.0001).Conclusions: The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%-5-fold higher than modeling estimates for low- and middle-income countries. Adults with HF were two decades younger and 7.7× more likely to die at 1 year compared with those in the community without HF. Further research characterizing the population burden of HF in low- and middle-income countries can guide resource allocation and development of pragmatic HF prevention and treatment interventions, ultimately reducing global cardiovascular disease health disparities.Registration: URL: https://www.Clinicaltrials: gov; Unique identifier: NCT03892265. [ABSTRACT FROM AUTHOR]

The article describes the case of a 33-year-old pregnant woman who went for her first prenatal visit. Topics covered include the question whether the patient should be offered a hepatitis B virus screening based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, and the recommended interventions once the patient screens positive of HBV.

Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system's ability to manage hypertension between 2011 and 2017. We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests:Dr Stokes reported receiving grants from Swiss Re and Johnson & Johnson outside the submitted work. No other disclosures were reported., (Copyright: © 2023 Benade et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)