Lamordé University Hospital or Lamordé National Hospital is a teaching hospital in Niamey, Niger. Affiliated with Abdou Moumouni University, the facility has 72 beds. It was the first public hospital in Niger to provide fistula repair services.
Background: Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa. Methods: We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies. Results: The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11–1.77)], complication of hypertension [OR 2.4 (1.89–3.03)], former hypertension [OR 3.12 (2.3–4.26)], good adherence [OR 1.98 (1.47–2.66)], from MIC [OR 1.38 (1.10–1.74)] and living in urban areas [OR 1.52 (1.16–1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC. Conclusion: In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.
Aims: To describe perioperative critical incidents, the conduct of anaesthesia and perioperative mortality in elective paediatric surgery patients in a national referral hospital in Niger. Methods: This is a prospective, observational study conducted from January to March 2018. All paediatric patients 15 years and younger, who underwent elective surgery in the Niamey National Hospital were included. The following variables were studied: age, sex, type of surgery, American Society of Anesthesiologists physical status (ASA PS) classification, monitoring system, anaesthesia technique, critical incidents, blood transfusion, analgesia, qualification of the anaesthesia practitioner, postoperative destination and mortality. Data were analysed with Excel 2007 and Epi Info 6 (TM) (Centers for Disease Control and Prevention Atlanta, GA). The chi(2) test was used for univariate associations with critical incidents. Statistical significance was considered if p < 0.05. Results: There were 231 (27.2%) paediatric patients of 849 surgical patients during the study period. Within the paediatric group, the mean age was 6 +/- 4 years. The male:female sex ratio was 1.65. A full blood count was completed preoperatively in all patients. Three per cent of the patients received a preoperative blood transfusion. The most frequently performed surgery was abdominal (42.4%). Most patients were classified as ASA PS I (55%) and ASA PS II (45%). General anaesthesia was performed in 96.1% of cases and spinal anaesthesia in 3.9%. The median duration of general anaesthesia was 63 (interquartile range 45-90) minutes. There were 27 reported critical incidents (11.7%), ten of which occurred during induction (4.9%), five intraoperatively (2.2%) and 12 postoperatively (5.2%). Multimodal postoperative analgesia was used in 33.8% of these patients. One patient died in the postoperative period (0.43%). Conclusion: Perioperative critical incidents in paediatric surgical patients in Niger remain high. To improve this situation requires paediatric training of anaesthetic staff, and improved paediatric monitoring and the use of safer anaesthesia agents.
contribution All authors made substantial contributions. MAn and XJ had full access to the whole data in the study and take responsibility for integrity of the data and accuracy of data analysis. They take responsibility for all aspects of the reliability and freedom from bias of presented data and their discussed interpretation. Study concept and design: MA, IBD, XJ. Responsible for data collection: IBD, KEK, IAT, DMB, BF, MDH, MSI, AK, SGKK, SK, CKK, LMK, CN, EL, JLT, JBM, ASA, RN, AD, JMD. Interpretation of data: all authors. Statistical analysis: PC, of the manuscript: revision of the manuscript for intellectual content: MAn, MAz, GST, XJ. approval of the version be published: all authors. High blood pressure (BP) is the main contributor to the global burden of chronic disease, reaching 10 million deaths each year. 1 In Africa, 130.2 million people suffer from hypertension and this figure is expected to reach 216.8 million by 2030. 2 A combination of lifestyle modification and BP-lowering medications is the cornerstone of hypertension control. Even though antihypertensive medications reduce hypertension-related complications, large-scale data on their use in Sub-Saharan Africa (SSA) are scarce. 3 Furthermore, most studies in SSA are limited to single countries or centers. 4 We aimed to describe BP control and antihypertensive drug strategies using a large multinational study conducted in 12 SSA countries: the EIGHT Study (Evaluation of Hypertension in Sub-Saharan Africa). 5 We conducted an observational cross-sectional study using data collected during outpatient consultations for hypertension in cardiology departments of 29 hospitals from 17 cities across 12 SSA countries. The EIGHT study was conceived by a multidisciplinary collaborative team of epidemiologists, cardiologists and pharmacists from Africa and France.
