Jean-Pierre Gervasoni

Knowledge, Attitudes, and Practices on Hypertension in a Country in Epidemiological Transition

Assessment of knowledge, attitudes, and practices (KAP) is a crucial element of hypertension control, but little information is available from developing countries where hypertension has lately been recognized as a major health problem. Therefore, we examined KAP on hypertension in a random sample of 1067 adults aged 25 to 64 years from the Seychelles Islands (Indian Ocean). KAP were assessed from an administered structured questionnaire. The age-standardized prevalence of hypertension (screening blood pressure [BP] > or = 160/95 mm Hg or taking antihypertensive medication) was 36% in men and 25% in women aged 25 to 64 years. Among hypertensive persons, 50% were aware of the condition, 34% were treated, and 10% had controlled BP (ie, BP <160/95 mm Hg). Most persons, whether nonhypertensive, unaware hypertensive, or aware hypertensive, had good basic knowledge related to hypertension determinants and consequences, possibly an effect of a nationwide cardiovascular disease prevention program over the last years. However, favorable outcome expectation, positive attitudes, and appropriate practices for hypertension and relevant healthy lifestyles were found in smaller proportions of participants, with little difference between aware hypertensives, unaware hypertensives, and nonhypertensives. Furthermore, hypertensive persons with other concurrent cardiovascular risk factors affecting the overall heart risk knew well the detrimental effects of these other factors but reported making little actual change to control them (particularly regarding overweight and sedentary habits). These data point to the need to maximize the efficiency of hypertension prevention and control programs so that delay in achieving effective hypertension control is minimized in countries experiencing recent emergence of hypertension as a major public health problem.

Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study

BackgroundDrug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management.MethodsA population-based survey of 9254 persons aged 25–64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP ≥ 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval.ResultsAmong the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care.ConclusionLow utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases.

Body size and blood pressure: an analysis of Africans and the African diaspora.

Background: Blood pressure is directly and causally associated with body mass index (BMI) in populations worldwide. However, the relationship may vary across BMI in populations of African origin. Methods: We compared the relationship between blood pressure and BMI in populations of African origin, using 13 samples from Africa, the Caribbean, the United Kingdom and the United States. We had access to data from individual participants for age, height, weight, blood pressure, and treatment of hypertension. Analysis was restricted to 18,072 participants (age 35–64 years; 44% men). We carried out multivariate regression analysis to estimate the relationship between blood pressure and BMI by country and by sex. The use of antihypertensive treatment was taken into account by exclusion and by sensitivity analysis. Results: There was a positive relationship between both systolic and diastolic blood pressure and BMI. In men the slopes for systolic blood pressure varied from 0.27 mm Hg per kg/m2 (95% confidence interval = −0.01 to 0.56) in the United States to 1.72 mm Hg per kg/m2 (95% confidence interval = 0.92 to 2.53) in Ghana (Kumasi). In women, the slopes varied from 0.08 (−0.54 to 0.72) in South Africa to 1.32 (0.98 to 1.66) in the Republic of Congo. Similar variation in trends was seen for diastolic blood pressure. The higher the BMI, the shallower the slopes [−0.10 (−0.15 to −0.06) for systolic, −0.09 (−0.12 to −0.06) for diastolic]. No differences were seen after excluding persons who were being treated for hypertension. Conclusions: Blood pressure and BMI levels vary among populations of the African diaspora. The effect of BMI on blood pressure levels diminishes as BMI increases. These results suggest a complex relationship among excess body weight, adiposity, and energy expenditure.

Mapping HIV/STI behavioural surveillance in Europe

BackgroundUsed in conjunction with biological surveillance, behavioural surveillance provides data allowing for a more precise definition of HIV/STI prevention strategies. In 2008, mapping of behavioural surveillance in EU/EFTA countries was performed on behalf of the European Centre for Disease prevention and Control.MethodNine questionnaires were sent to all 31 member States and EEE/EFTA countries requesting data on the overall behavioural and second generation surveillance system and on surveillance in the general population, youth, men having sex with men (MSM), injecting drug users (IDU), sex workers (SW), migrants, people living with HIV/AIDS (PLWHA), and sexually transmitted infection (STI) clinics patients. Requested data included information on system organisation (e.g. sustainability, funding, institutionalisation), topics covered in surveys and main indicators.ResultsTwenty-eight of the 31 countries contacted supplied data. Sixteen countries reported an established behavioural surveillance system, and 13 a second generation surveillance system (combination of biological surveillance of HIV/AIDS and STI with behavioural surveillance). There were wide differences as regards the year of survey initiation, number of populations surveyed, data collection methods used, organisation of surveillance and coordination with biological surveillance. The populations most regularly surveyed are the general population, youth, MSM and IDU. SW, patients of STI clinics and PLWHA are surveyed less regularly and in only a small number of countries, and few countries have undertaken behavioural surveys among migrant or ethnic minorities populations. In many cases, the identification of populations with risk behaviour and the selection of populations to be included in a BS system have not been formally conducted, or are incomplete. Topics most frequently covered are similar across countries, although many different indicators are used. In most countries, sustainability of surveillance systems is not assured.ConclusionAlthough many European countries have established behavioural surveillance systems, there is little harmonisation as regards the methods and indicators adopted. The main challenge now faced is to build and maintain organised and functional behavioural and second generation surveillance systems across Europe, to increase collaboration, to promote robust, sustainable and cost-effective data collection methods, and to harmonise indicators.

A high proportion of users of low-threshold facilities with needle exchange programmes in Switzerland are currently on methadone treatment: Implications for new approaches in harm reduction and care

BACKGROUND Increasingly, patients receiving methadone treatment are found in low threshold facilities (LTF), which provide needle exchange programmes in Switzerland. This paper identifies the characteristics of LTF attendees receiving methadone treatment (MT) compared with other LTF attendees (non-MT). METHODS A national cross-sectional survey was conducted in 2006 over five consecutive days in all LTF (n=25). Attendees were given an anonymous questionnaire, collecting information on socio-demographic indicators, drug consumption, injection, methadone treatment, and self-reported HIV and HCV status. Univariate analysis and logistic regression were performed to compare MT to non-MT. The response rate was 66% (n=1128). RESULTS MT comprised 57.6% of the sample. In multivariate analysis, factors associated with being on MT were older age (OR: 1.38), being female (OR: 1.60), having ones own accommodation (OR: 1.56), receiving public assistance (OR: 2.29), lifetime injecting (OR: 2.26), HIV-positive status (OR: 2.00), and having consumed cocaine during the past month (OR: 1.37); MT were less likely to have consumed heroin in the past month (OR: 0.76, not significant) and visited LTF less often on a daily basis (OR: 0.59). The number of injections during the past week was not associated with MT. CONCLUSIONS More LTF attendees were in the MT group, bringing to light an underappreciated LTF clientele with specific needs. The MT group consumption profile may reflect therapeutic failure or deficits in treatment quality and it is necessary to acknowledge this and to strengthen the awareness of LTF personnel about potential needs of MT attendees to meet their therapeutic goals.

Discordant prevalence of hypertension using two different automated blood pressure measurement devices : a population-based study in Dar es Salaam (Tanzania)

ObjectiveThe estimation of blood pressure is dependent on the accuracy of the measurement devices. We compared blood pressure readings obtained with an automated oscillometric arm-cuff device and with an automated oscillometric wrist-cuff device and then assessed the prevalence of defined blood pressure categories. MethodsWithin a population-based survey in Dar es Salaam (Tanzania), we selected all participants with a blood pressure ≥160/95 mmHg (n=653) and a random sample of participants with blood pressure <160/95 mmHg (n=662), based on the first blood pressure reading. Blood pressure was reassessed 2 years later for 464 and 410 of the participants, respectively. In these 874 subjects, we compared the prevalence of blood pressure categories as estimated with each device. ResultsOverall, the wrist device gave higher blood pressure readings than the arm device (difference in systolic/diastolic blood pressure: 6.3±17.3/3.7±11.8 mmHg, P<0.001). However, the arm device tended to give lower readings than the wrist device for high blood pressure values. The prevalence of blood pressure categories differed substantially depending on which device was used, 29% and 14% for blood pressure <120/80 mmHg (arm device versus wrist device, respectively), 30% and 33% for blood pressure 120–139/80–89 mmHg, 17% and 26% for blood pressure 140–159/90–99 mmHg, 12% and 13% for blood pressure 160–179/100–109 mmHg and 13% and 14% for blood pressure ≥180/110 mmHg. ConclusionsA large discrepancy in the estimated prevalence of blood pressure categories was observed using two different automatic measurement devices. This emphasizes that prevalence estimates based on automatic devices should be considered with caution.

S11.3 Switzerland: National Trends in Sexual Behaviour in the Context of HIV/STI Behavioural Surveillance 1987–2012

Background National trends in sexual behaviour have been assessed mainly in the context of the HIV related behavioural surveillance system set up in Switzerland between 1987 and 1992. Methods Several populations are included in the system. Repeated surveys have been regularly conducted among the general population and youth, men having sex with other men (MSM), injecting drug users (IDU). Data on sexual behaviour are regularly recorded among people living with HIV/Aids (PLWHA) included in the Swiss HIV Cohort. Results The main trends observed are : In young adults (aged 18–20): a steady increase in the proportion of sexually active at age 17 a stable median number of partners with a recent increase in the proportion of multipartners; a high and stable level of condom use among multipartners. Among MSM: an increase in the number of partners and a steady increase in unprotected anal intercourse since 1997, after a period of decreasing trends. Among IDU: a low and stable use of condoms with stable partners; a high and stable use of condoms with occasional and paying partners (only among women) with a possible recent decreasing trend. Among PLWHA: a high use of condoms with all types of partners with a recent decrease. Conclusions The behavioural surveillance system in place allowed to assess various trends in sexual behaviour in several populations such as: long term trends regarding sexual debut, stable trends and recent changes regarding different indicators of sexual activity in the general population, IDU and PLWHA, inversion of trends in sexual activity and condom use among MSM.

Monitoring des activités des structures à bas-seuil d'accès pour consommateurs de drogues en Suisse: Remise de matériel d'injection stérile, résultats pour 1993 et quelques exemples cantonaux

In Switzerland numerous structures distribute or sell sterile injecting equipment for i.v. drug users, low threshold centres (LTCs) being the major provider. A national survey of these centres was initiated by the UEPP in january 1993, in the context of the global evaluation of the new set of the federal measures to reduce the problems related to illegal drug use. This article concentrates mainly on the results of the monitoring activity of the LTCs, which in 1993 distributed 7.1 millions syringes. This important offer is not, however, uniform across the different regions of the country. Some examples of regional variations are presented, as are fluctuations of demand in many LTCs. The observed variations can be correlated with season (increased demand in summer), but also with the development of LTCs (opening /closing down of centre, change in the structure, opening hours, etc.) and with external events (policy, increased pressure from police, etc.). This type of monitoring is useful not only for researchers in the field of drug addiction and prevention of HIV/AIDS, but also for decision makers and actors in the field of public health. The recommendations based on the first three years of this monitoring suggest that efforts to prevent sexual transmission of HIV among i.v. drug users should be reinforced as well as measures to supply sterile injecting equipment and condoms at low threshold level must be continued and further developed.

Guidelines for a collaborative long term programme of reduction of cardiovascular risk factors in the population of the Seychelles

Evidence of a high incidence of cardiovascular diseases in the Seychelles. Evidence of high cardiovascular risk factor levels in the population, as shown by the Seychelles Cardiovascular Diseases Survey carried out in 1989. Scientific evidence that a decrease of the incidence of cardiovascular diseases may be achieved by a reduction of the cardiovascular risk factors levels in the population. Limited economic and scientific resources in the Seychelles urging for a collaborative action. Small and centralized country, with a well organized health system, allowing a prevention programme to be carried out in good conditions.