Posts or Comments 25 May 2022

Archive for "NCDs"



Chronic/NCDs &NCDs &Schools &Training Bill Brieger | 19 Nov 2021

Hands-only CPR Training Program of Secondary School Students in Ibadan, Nigeria

NCDs are increasingly being recognized as health problems in Nigeria and other LMICs.  Here, Bolanle Akinyele, Olufunso Odunukan, Oluwaseyi Bolorunduro, and William Brieger describe a Pilot project to help high school students learn to perform CPR through a Combination Virtual and In-person Learning. This is being presented at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting.

Out-of-hospital cardiac arrest (OHCA) is estimated to have an average global incidence of 55 adults per 100,000 person-years. However, despite advances in medical care and technology, survival to hospital discharge remains abysmally low at 8-10%. In low to middle income countries like Nigeria, where cardiovascular disease is rising but emergency response systems are poor, the rate of survival after OHCA is lower.

Interventions such as bystander cardiopulmonary resuscitation (CPR) training and automated external defibrillator (AED) use are effective, scalable, and low-cost interventions that can reduce the OHCA mortality. Training schoolchildren to perform Hands-only CPR has been shown to increase bystander CPR.

Cardiopulmonary Resuscitation Peer Educator’s Program (CPEP) is a community-based program in Ibadan, Nigeria, designed enhance understanding of CPR in secondary school students. The American Heart Association’s school health module was adapted. The training was run jointly by staff of the four pilot schools, a Nigerian NGO, and the Revolving Hearts Foundation, Atlanta.

The training had both in-person and virtual components due to COVID-19 travel restrictions on Atlanta based partners. Here we present the results of training on knowledge, comfort level and perceived barriers of performing hands-only CPR.

A pre-training survey was conducted in February 2021 using convenience sampling that also was used to recruit participants. Pre- and post- training responses were matched by participants to assess the changes. Data were analyzed using Stata 16.1 software. A paired t-test analysis was conducted. The primary outcome was a percentage change in mean knowledge scores and secondary outcome was a change in comfort level and perceived barriers pre- and post- training.

A total of 45 secondary school students from 4 schools completed the tests. Females comprised 31.1% of students and the average age was 15.02 + 0.18 years. Paired t-test showed a significant change of 44.6% (p <0.0001) in the mean knowledge score. There was also an increase in comfort level in performing hands-only CPR, and a decrease in perceived barriers.

Trainees have started sharing what they learned through skits at school assemblies. Planning is underway to follow-up on training and to expand to other schools and states.

PS: as a followup another training session with a new group of 45 students and 15 teachers was conducted. The students made videos of their understanding of CPR from the program so it could be used for peer education, and most of them were pretty good and creative.

Burden &Malaria in Pregnancy &NCDs Bill Brieger | 16 May 2014

Malaria, Hypertension and Pregnancy: where communicable and non-communicable diseases may cross paths

WorldHypertensionDay_SmallTomorrow, May 17th, is World Hypertension Day.  Much attention of recent has been focused on the importance of non-communicable diseases (NCDs) like hypertension in terms of global burden, and concerns have been expressed that communicable or infectious diseases (CDs) may become neglected, although they still cause huge levels of morbidity and mortality. What people may not realize is that there are connections between the NCDs and the CDs.

World Hypertension DayBetter research is needed to document the relationships and influences of one on the other, but some preliminary work has been done with pregnant women who are susceptible to both hypertension and malaria.  What does that combination do?

What the existing literature implies so far is that malaria in pregnancy may in fact be associated with hypertension in some cases and that both conditions can lead to intra-uterine growth retardation and low birth weight.  Also boys who were born to mothers with malaria in pregnancy had excess hypertension in their first year of life and girls had higher SBP.

Hypertension malaria LBWThe role of malaria in pregnancy in low birth weight is well established. Furthermore Lackland and colleagues shared that, “there have been numerous ecologic and observational studies that identified significant inverse associations of birth weight with blood pressure levels at various ages in later life.” A graphic posted to the right shows potential malaria and hypertension interactions. These are areas that deserve more observation, documentation and research.

Overall we can see that there is not a real dichotomy between CDs and NCDs, and both interact in the health of individuals, families and communities.

Cancer &NCDs &Treatment Bill Brieger | 02 Feb 2014

Malaria and Cancer: World Cancer Day on 4th February

wcd-badgeAs World Cancer Day approaches it is worth considering the connections between communicable and non-communicable diseases.  Below are some brief extracts from recent studies that show relationships between malaria and cancers when it comes to diagnostics, drug research, treatment, prevention and epidemiology.

PLoS One has a new article entitled: “Sloth Hair as a Novel Source of Fungi with Potent Anti-Parasitic, Anti-Cancer and Anti-Bacterial Bioactivity.” The authors found that, “Seventy-four isolates were cultivated in liquid broth and crude extracts were tested for bioactivity in vitro. We found a broad range of activities against strains of the parasites that cause malaria (Plasmodium falciparum) and Chagas disease (Trypanosoma cruzi), and against the human breast cancer cell line MCF-7.”

The Nature Group’s Scientific Reports sheds some more light on links between malaria and Burkitts lymphoma in the article “Relationship between Plasmodium falciparum malaria prevalence, genetic diversity and endemic Burkitt lymphoma in Malawi”. The researchers report that, “Endemic Burkitt lymphoma (eBL) has been linked to Plasmodium falciparum (Pf) malaria infection, but the contribution of infection with multiple Pf genotypes is uncertain… Further work is needed to evaluate the possible role of Pf genetic diversity in the pathogenesis of endemic BL.”

Recently KH Khan drew our attention to the fact that, “DNA vaccines against cancer, tuberculosis, Edwardsiella tarda, HIV, anthrax, influenza, malaria, dengue, typhoid and other diseases,” have been explored. It was noted that “These vaccines function by generating the desired antigen inside the cells, with the advantage that this may facilitate presentation through the major histocompatibility complex.”

DSCN8367Hematologists must also deal with a variety of communicable and non-communicable diseases that affect red blood cells. According to Fedovsov and colleagues, “Hematologic disorders arising from infectious diseases, hereditary factors and environmental influences can lead to, and can be influenced by, significant changes in the shape, mechanical and physical properties of red blood cells (RBCs), and the biorheology of blood flow,” as well as broad spectrum of hematologic disorders including certain types of cancer.

Again in the area of drug research, Hooft van Huijsduijnen and colleagues explore the “Anticancer properties of distinct antimalarial drug classes.” Within these drug classes the researcher observed that “Several of the antimalarials tested in this study have well-established and excellent safety profiles with a plasma exposure, when conservatively used in malaria, that is well above the IC50s that we identified in this study. Given their unique mode of action and potential for unique synergies with established anticancer drugs, our results provide a strong basis to further explore the potential application of these compounds in cancer in pre-clinical or/and clinical settings.”

We need to maintain a broader vision of human health past the 2015 Millennium Development Goals and neglect neither communicable nor non-communicable diseases, but see synergies and complementarities in working on both together.