Mario J. Azevedo

Relationship of Low Birth Weight to Pulsatile Arterial Function in Asymptomatic Younger Adults: The Bogalusa Heart Study

BACKGROUND Low birth weight, an indicator of intrauterine growth restriction, is associated with adult cardiovascular (CV) disease, type 2 diabetes, and adverse levels of CV risk factors. Impaired pulsatile arterial function is also an independent predictor of early vascular damage and related CV outcome. However, information is scant regarding the influence of low birth weight on pulsatile arterial function. METHODS The study cohort consisted of 538 black and white subjects (29% black, 42% male) aged 18-44 years (mean 36.7 years) enrolled in the Bogalusa Heart Study. Subjects were categorized into low birth weight and normal birth weight. Pulsatile arterial function was assessed in terms of large artery compliance, small artery compliance, and systemic vascular resistance by noninvasive radial artery pressure pulse contour analysis. RESULTS Blacks and females had significantly lower birth weight compared to their counterparts. Low vs. normal birth weight group had lower large artery compliance (13.3 ml/mm Hg x 10 vs. 15.5 ml/mm Hg x 10, P = 0.0002). Further, after adjusting for age, race, and sex, the large artery compliance increased across quartiles of increasing birth weight specific for race, sex, and gestational age (P for trend = 0.03). In multivariate regression model, adding race, sex, age, body surface area, systolic blood pressure, diastolic blood pressure, triglycerides/high-density lipoprotein cholesterol ratio one by one, the effect was attenuated but significant (beta = -0.067, P = 0.033). CONCLUSIONS The observed deleterious association of low birth weight on arterial wall dynamics in asymptomatic younger adults may account in part for the adverse CV risk in the Bogalusa sample.

Influence of low birth weight on C-reactive protein in asymptomatic younger adults: the bogalusa heart study

BackgroundBoth low birth weight, an indicator of intrauterine growth restriction, and low grade systemic inflammation depicted by high sensitivity C-reactive protein (hs-CRP) have emerged as independent predictors of cardiovascular (CV) disease and type 2 diabetes. However, information linking low birth weight and hs-CRP in a biracial (black/white) population is scant. We assessed a cohort of 776 black and white subjects (28% black, 43% male) aged 24-43 years (mean 36.1 years) enrolled in the Bogalusa Heart Study with regard to birth weight and gestational age data were retrieved from Louisiana State Public Health Office.FindingsBlack subjects had significantly lower birth weight than white subjects (3.145 kg vs 3.441 kg, p < 0.0001) and higher hs-CRP level (3.29 mg/L vs 2.57 mg/L, p = 0.011). After adjusting for sex, age, body mass index (BMI), smoking status and race (for total sample), the hs-CRP level decreased across quartiles of increasing birth weight in white subjects (p = 0.001) and the combined sample (p = 0.002). Adjusting for sex, age, BMI, smoking status and race for the total sample in a multivariate regression model, low birth weight was retained as an independent predictor variable for higher hs-CRP levels in white subjects (p = 0.004) and the total sample (p = 0.007). Conversely, the area under the receiver operative curve (c statistic) analysis adjusted for race, sex, age, smoking status and BMI yielded a value of 0.777 with regard to the discriminating value of hs-CRP for predicting low birth weight.ConclusionsThe deleterious effect of low birth weight on systemic inflammation depicted by the hs-CRP levels in asymptomatic younger adults may potentially link fetal growth retardation, CV disease and diabetes, with important health implications.

Africa’s Health System(s) Performance on the Millennium Development Goals (MDGs)

This chapter assesses the achievement of the eight MDS goals and their subsections by the countries that subscribed to them. The reader is reminded that this issue is still in progress and the following assessment relies mainly on the WHO annual reports, the series of comprehensive global articles written by a cadre of hundreds of experts and published in The Lancet over the past five years, and a few other sources. On Africa, the World Health Organization notes that, notwithstanding the problems, the African continent has made progress in its effort to achieve some of the MDGs. As many experts have said, the MDGs are a good way of moving and integrating Africa’s health systems into the advance developments of the twenty-first century. However, if one assesses carefully the efforts to achieve them, only three African countries—Burkina Faso, Mozambique, and Namibia—lead the way in accelerated progress in 16 of the 22 indicators assessed so far. Several countries in North, Southern, East, Central and West Africa, have also improved their rate of progress and are listed among the top 20 countries that have shown some progress in most health indicators. In North Africa, Egypt has progressed in 11 indicators, followed by Morocco in nine, and Tunisia in eight.

The State of Health System(s) in Africa: Challenges and Opportunities

As study after study has pointed out, the health care systems in Africa pay little attention to the critical interface between education and good health, especially when it comes to the education of women and mothers, who are the primary line of defense against child diseases, and perform simultaneously most domestic chores and critical agricultural activities. While many medical educational institutions on the continent tend to perpetuate, at times, skewed and irrelevant Eurocentric health training, the national pyramidal health structure, weakened at the village level, and disproportionately favoring the provincial and national hospitals, gives the illusion that rural areas are well-served, when in actuality they are not. This chapter endorses the restrengthening of an uncompromised health care system to make it effective and efficient for both rural and urban areas; one that finds ways of trimming financial and human resource waste; revamps the institutions that train health care and service providers to make the system responsive to the real health needs of the people and not just the wealthy; one that compensates physicians just as civil servants; and aligns the educational system with targeted and expected measurable health outcomes.

The Colonial Medical System(s) and the Health of Africans

We might agree that the health care systems prevalent in Africa today are a relic of the colonial past, primarily initiated during the nineteenth century. Following attainment of independence during the 1960s and 1970s, the new African sovereign states attempted to reverse the course of their histories by announcing that health and education would be free for all citizens—in line with their leaders’ common admiration for the socialist ideology and rhetoric of the Non-Aligned Movement states and the Soviet Union. The latter had provided much assistance to the bold liberation movements and the new independent states in Africa. However, many factors have harmed Africa’s fledgling health care systems: scarcity of resources, geographic location, lack of exposure to commercial activities with the outside world, especially for landlocked countries, improper allocation of funds, and corruption; also, simply the bad choices made in the face of competing priorities. As such, its leaders must be held responsible for the unacceptable health disparities that prevail on the continent today. The colonial legacy might explain partly the differences found in countries’ health care performance and this chapter argues that the colonial health model has left an indelible mark on the existing health care system(s) in Africa. To the informed observer, there is a noticeable difference between countries that were under colonial indirect rule, or faced assimilation, or a more paternalistic form of governance. However, whatever the nuances of their approach, all colonizing states were intent primarily on extracting from Africa what would be beneficial particularly to their citizens, economies and status. It made sense for Europe, a continent divided by long-standing political, religious, and economic rivalries, to use Africa to leverage the humiliations suffered following the concretization and stabilization of the concept of nation-state in Europe during the seventeenth century.

The Health of Africans: Portuguese, Belgian, Italian, Spanish, and German Rule

This chapter starts with a brief discussion of the demographic impact of the various colonial policies in Africa, which are said to have caused or were associated with the recurrence of famine and hunger and infertility, as well as the resulting depopulation in almost every colony, and the rapid spread of disease. Studies of the colonial period show that concern about higher infertility among colonized Africans was more pronounced among the concessionaire companies’ work areas, particularly in French Equatorial Africa, Chad, Oubangui-Shari (Central African Republic), Congo, and Gabon, and in such East African territories as Uganda (Retel-Laurentin 1974; Romaniuk 1967). The concern for infertility forced the French colonial regime, which suspected that the condition was a result of the ravages of sleeping sickness, to initiate major campaigns against epidemics during the 1920s. In fact, Denis Cordell, writing on infertility in Equatorial Africa, noted that: “At the end of the nineteenth century, Oubangui-Shari was characterized by high and increasing mortality, by what was probably the manifestation of low fertility and some sterility, and by new patterns of more intensified migration. Morbidity and the health environment in general, probably suffered rapid deterioration, particularly with the introduction of new diseases and the epidemic outbreak of old ones. ” All this was certainly exacerbated by new epidemics, slavery, and colonialism, causing the higher devastation during the first 10 years of 1900. Cordell et al. put it in no unclear terms:

African Traditional Therapeutics: Disease Causation, Agency, and Efficacy

This chapter purports not only to chronicle the existence of centuries-old health care practices that have served the African people, but also to assess their impact, importance, and future. The African continent is under immense pressure from Western-trained physicians, governments, and religious organizations which, while continuing to pay lip service to the World Health Organization (WHO)’s urgent call for African traditional therapeutics incorporation into the national therapeutic systems, are intent on playing down the so-called “unscientific” and unproven medical practices and eventually eliminating them altogether. The move towards accomplishing this goal has been slow because traditional health care practices are still extremely popular in Africa. Authorities fear the citizens’ angry reaction if they were to eliminate them through a national fiat. Any open radical proscription of the sanctioned health care traditions could, in fact, result in the call for the removal of any politician suggesting that these culturally based but honored traditions be discontinued.

British “Health Effort” in Colonial Africa

This chapter covers the British obsession for the separation of Africans from Europeans in residential patterns in order to insulate the two from the one-way contagion of diseases (from Africans to Europeans) alleged by the Europeans during the period in which they declared wars on epidemic infections in the colonial territories. It was curious that, despite the fact that the Europeans abhorred the tropics due to hot climate and associated diseases, most British officials thought at first they were invulnerable, to the extent that officials wore short khaki pants and sleeveless shirts, no matter how hot the temperatures might be in the tropical rainforest or the desert areas of Africa. Given that most of the new facilities would be constructed primarily for Europeans, the building policies resulted necessarily in segregation between whites and blacks and, in many instances—as in Accra, Ghana, Douala in Cameroon, and Dar-es-Salaam, in Tanganyika—the policy met violent resistance from Africans whose land and businesses were expropriated or moved to a different part of the countryside or city to provide space for European settlement. In Ghana, Governor Sir Matthew Nathan was very clear about what the Africans could bring to European sections, “if people were not segregated, as he thought Africans were not concerned about sanitation and doubted that they ever would” (Roberts 2003: 2).

Population in Transition: North Africa’s Health and Health Care System(s)

This chapter begins with general remarks about the health and health status of North Africa followed by a discussion of the conditions in each individual country often lumped together as the Maghreb and the Middle East. As a result, some individual observations may be a contrast to, or overlap at times with, the general remarks made about the conditions of the region, particularly when there is a need to sharpen what is known about the Arab states facing the Atlantic and the Indian Oceans, the Red Sea, and the Mediterranean Sea. Unlike Sub-Saharan Africa, much less is known about the state of health and health care in North Africa.

Public Health in Africa: Theoretical Framework

These are examined as parts of the health or medical systems from an historical perspective that enables the reader to link the present to the past and vice-versa.