EDITORIAL: Mitigating the Burden of Hypertension in Developing Nations and the Global Impact of Covid-19 Vaccine

West Afr J Med. 2021 Mar 22; 38(3):197-198. PMID: 33764658

Abstract

It is with great delight that I present this edition of the West African Journal of Medicine. I am particularly intrigued by the diversity of articles presented in this edition, cutting across numerous fields in Medicine and Surgery and reflecting the resourcefulness of our authors in their fields. I especially welcome the editorial by Prof. Otuyemi on A three-year audit of Orthodontic Retention Protocol in a Nigerian tertiary health institution. Future editions will expand the editorial column to accommodate many authors from diverse fields.

Hypertension continues to be a deadly disease despite preventive measures. It remains one of the most important risk factors for ischemic heart disease, stroke, and kidney disease.¹ Despite advances in management of hypertension over the years, the global prevalence is rising, especially in rural populations. This has been attributed to changes in lifestyle, population growth, and an aging population.² The impact of the disease on the populace cannot be over-emphasized as complications from hypertension continue to abound. Presently, it affects over 1 billion people globally and continues to be the highest single contributor to global burden of disease and mortality.³

About 75% of people with hypertension live in low- and middle-income countries with an estimated 74.7 million in Sub-Saharan Africa.⁴ Major issues affecting the rural populace are the gross unawareness of hypertensive status, poverty, poor drug and clinic compliance, lack of access to specialist care, and religious and traditional myths that foster poor health-seeking behaviours. More often than not, hypertension is diagnosed when patients present with complications at the hospital and this gives cause for concern. The article on ‘Hypertension and its clinical correlates in a rural community,’ in this edition, further sheds light on this rising scourge in our rural communities, as many of the patients presented with left ventricular hypertrophy and florid cardiovascular risk factors.

The lesson that is being learnt repeatedly is that we must increase awareness and tighten the reins of blood pressure control if we must mitigate the impact of disease. Studies on long-term awareness and trends in hypertension management has shown that even in highly developed best performing countries, treatment coverage was at most 80% and control rates were less than 70%.¹ Hence, the need for intensive and sustained awareness is paramount, if we must overcome this scourge. Training of healthcare professionals on current guidelines and adherence to the guidelines, ensuring patients compliance with medications, promoting regular blood pressure measurements, establishing a hypertension registry, reducing pill-burden by opting for single-pill therapy, and providing ready access to healthcare in rural communities, will also go a long way to ensure control and reduce prevalence of hypertension.

COVID-19 continues to be a deadly disease with multisystemic affectations and associated with various complications and co-morbidities. Renal involvement has been found to be a predictor of disease severity, prolonged hospitalization, need for intensive care admission, and mortality, with renal patients having a 2-fold risk of death. Histopathological findings on autopsy of patients reveals vacuolar degeneration, diffuse proximal tubular injury with loss of brush border, frank necrosis, and prominent erythrocyte aggregation obstructing capillary lumen on light microscopy. Clusters of coronavirus particles with distinctive spikes in tubular epithelium and podocytes can be seen on electron microscopy.⁵ This shows the multiorgan involvement seen in this disease.

In this edition, we had two case reports on the Impact of impaired kidney function on outcomes of Nigerians with COVID-19 infection. These two cases experienced acute deterioration of an existing CKD, had associated worsening respiratory failure, gross metabolic derangement and eventually resulted in mortality. The severity experienced in patients with impaired kidney function is high, emphasizing the need for strict infection prevention and control, early detection and prompt management in this cohort of patients.

The impact of the corona virus disease on lifestyle and health practices continues unabated as many people still live in morbid fear of contracting the virus. This has resulted in diverse preventive practices ranging from the use of traditional herbal medications to indiscriminate use of antibiotics and antimalarials.⁶ It has been noticed that the safety guidelines provided by the Centre for disease control of many nations are being neglected with many people seeking antiviral medications and immune boosters. In this edition, a study on Determinants of Anti-microbial Use for COVID-19 related symptoms among Nigerians found high levels of antimicrobial use among the populace. This is particularly worrisome as it could lead to the emergence of antimicrobial resistance in not-too-distant future. Health agencies at both private and public levels must join hands to provide correct and up-to-date information to the populace regarding the deleterious effect of indiscriminate antimicrobial use and proper infection prevention guidelines to follow in COVID-19. 

The distribution of COVID-19 vaccine is spreading further. Globally, over 335 million doses of the coronavirus vaccines have been administered, in more than 100 countries.⁷ Some countries have gotten their shipments and vaccinated a large proportion of their population but many more are still awaiting their first shipments. The effect of the vaccine is becoming obvious on the global page as countries who have vaccinated large populations have started experiencing a drop in incidence and death rates. Low-and-middle income countries have started taking delivery of the vaccine in batches and some have started vaccinating their citizens. However, a number of concerns have been raised over the side effects of some of the vaccines being given. Reports of blood clots following vaccination have resulted in eight countries suspending the Astra Zeneca vaccine over safety concerns. The World Health Organization (WHO) and the European Medicines Agency (EMA) have said that there is no link between the vaccine and reports of blood clots. However, many countries are treading with caution while some are delaying roll-out until these reports are fully clarified. While minimal side effects such as fatigue, headache, muscle aches, chills, joint pain, and possibly fever may be easier to handle, life threatening ones such as blood clots need to be properly investigated.

COVID-19 has opened up a vast area of research and colleagues are encouraged to do quality research in this area, as it affects their field. WAJM remains one of the leading journals providing international exposure to research studies by researchers and clinicians in Africa. We encourage you to keep sending your manuscripts for review and subsequent publication in this vastly informative journal. You are assured of critical, unbiased, prompt and in-depth review of manuscripts and subsequent publishing, if found suitable.

REFERENCES

1. NCD Risk Factor Collaboration (NCD-RisC). Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. Lancet 2019; 394: 639–51
2. Dzau V. J., Balatbat C.A. Future of Hypertension - The Need for Transformation. Hypertension. 2019; 74:450–457
3. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017; 389:37–55
4. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries.Circulation. 2016; 134:441–450.
5. Oghenekaro Godwin Egbi et al. Coronavirus infection and kidney disease: a review of current and emerging evidence. Pan African Medical Journal. 2020;37:149. doi: 10.11604/pamj.2020.37.149.23655
6. Ngwewondo A, Nkengazong L, Ambe LA, Ebogo JT, Mba FM, Goni HO, et al. Knowledge, attitudes, practices of/towardsCOVID19 preventive measures and symptoms: A cross-sectional study during the exponential rise of the outbreak in Cameroon. PLoSNegl Trop Dis 2020; 14(9):e0008700

Covid vaccines: How fast is progress around the world? https://www.bbc.com/news/world-56237778