Perceptions of chest pain and healthcare seeking behavior for chest pain in northern Tanzania: A community-based survey

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Abstract

Background

Little is known about community perceptions of chest pain and healthcare seeking behavior for chest pain in sub-Saharan Africa.

Methods

A two-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified household healthcare decision-makers from randomly selected households were asked to list all possible causes of chest pain in an adult and asked where they would go if an adult household member had chest pain.

Results

Of 718 respondents, 485 (67.5%) were females. The most commonly cited causes of chest pain were weather and exercise, identified by 342 (47.6%) and 318 (44.3%) respondents. Two (0.3%) respondents identified ‘heart attack’ as a possible cause of chest pain. A hospital was selected as the preferred healthcare facility for an adult with chest pain by 277 (38.6%) respondents. Females were less likely to prefer a hospital than males (OR 0.65, 95% CI 0.47–0.90, p = 0.008).

Conclusions

There is little community awareness of cardiac causes of chest pain in northern Tanzania, and most adults reported that they would not present to a hospital for this symptom. There is an urgent need for educational interventions to address this knowledge deficit and guide appropriate care-seeking behavior.

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Most cited references 14

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Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events.

Klane White, Gilles Montalescot, David Brieger … (2004)

The clinical manifestations of acute coronary syndromes (ACSs) vary, and patients present frequently with symptoms other than chest pain. In this analysis, a large contemporary database has been accessed to define the frequency, clinical characteristics, and outcomes of patients presenting without chest pain across different diagnostic categories of ACS. The Global Registry of Acute Coronary Events is a multinational, prospective, observational study involving 14 countries. Patients presenting to the hospital with a suspected ACS were stratified according to whether their predominant presenting symptoms included chest pain (ie, typical) or did not (ie, atypical). Demographics, medical history, hospital management, and outcomes were compared. Of the 20,881 patients in this analysis, 1,763 (8.4%) presented without chest pain, 23.8% of whom were not initially recognized as having an ACS. They were less likely to receive effective cardiac medications, and experienced greater hospital morbidity and mortality (13% vs 4.3%, respectively; p < 0.0001) than did patients with typical symptoms. After adjusting for potentially confounding variables, increased hospital mortality rates were noted in patients with dominant presenting symptoms of presyncope/syncope (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 2.9), nausea or vomiting (OR, 1.6; 95% CI, 1.1 to 2.4), and dyspnea (OR, 1.4; 95% CI, 1.1 to 1.9), and in those with painless presentations of unstable angina (OR, 2.2; 95% CI, 1.4 to 3.5) and ST-segment elevation myocardial infarction (OR, 1.7; 95% CI, 1.2 to 2.2). Patients with ACSs who present without chest pain are frequently misdiagnosed and undertreated. With the exception of diaphoresis, each dominant presenting symptom independently identifies a population that is at increased risk of dying. These patients experience greater morbidity and a higher mortality across the spectrum of ACSs.

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A time bomb of cardiovascular risk factors in South Africa: results from the Heart of Soweto Study "Heart Awareness Days".

David Wilkinson, Simon Stewart, Trevor Gerntholtz … (2009)

There is strong anecdotal evidence that many urban communities in Sub-Saharan Africa are in epidemiologic transition with the subsequent emergence of more affluent causes of heart disease. However, data to describe the risk factor profile of affected communities is limited. During 9 community screening days undertaken in the predominantly Black African community of Soweto, South Africa (population 1 to 1.5 million) in 2006-2007, we examined the cardiovascular risk factor profile of volunteers. Screening comprised a combination of self-reported history and a clinical assessment that included calculation of body mass index (BMI), blood pressure and random blood glucose and total cholesterol levels. In total, we screened a total of 1691 subjects (representing almost 0.2% of the total population). The majority (99%) were Black African, there were more women (65%) than men and the mean age was 46+/-14 years. Overall, 78% of subjects were found to have >or=1 major risk factor for heart disease. By far the most prevalent risk factor overall was obesity (43%) with significantly more obese women than men (23% versus 55%: OR 1.76 95% CI 1.62 to 1.91: p<0.001). A further 33% of subjects had high blood pressures (systolic or diastolic) and 13% an elevated (non-fasting) total blood cholesterol level: no statistically significant differences between the sexes were found. There was a positive correlation between increasing BMI and other risk factors including elevated systolic (r(2)=0.046, p<0.001) and diastolic blood pressure (r(2)=0.032, p<0.001) with overweight subjects three times more likely to have concurrent hypercholesterolemia (OR 3.3, 95% CI 2.1 to 5.3: p<0.01). These unique pilot data strongly suggest a high prevalence of related risk factors for heart disease in this urban black African population in epidemiologic transition. Further research is needed to confirm our findings and to determine their true causes and potential consequences.

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Prevalence, Risk Factors, and Complications of Diabetes in the Kilimanjaro Region: A Population-Based Study from Tanzania

John Stanifer, Charles Cleland, Gerald Jamberi Makuka … (2016)

Background In sub-Saharan Africa, diabetes is a growing burden, yet little is known about its prevalence, risk factors, and complications. To address these gaps and help inform public health efforts aimed at prevention and treatment, we conducted a community-based study assessing diabetes epidemiology. Methods and Findings We conducted a stratified, cluster-designed, serial cross-sectional household study from 2014–2015 in the Kilimanjaro Region, Tanzania. We used a three-stage cluster probability sampling method to randomly select individuals. To estimate prevalence, we screened individuals for glucose impairment, including diabetes, using hemoglobin A1C. We also screened for hypertension and obesity, and to assess for potential complications, individuals with diabetes were assessed for retinopathy, neuropathy, and nephropathy. We enrolled 481 adults from 346 urban and rural households. The prevalence of glucose impairment was 21.7% (95% CI 15.2–29.8), which included diabetes (5.7%; 95% CI 3.37–9.47) and glucose impairment with increased risk for diabetes (16.0%; 95% CI 10.2–24.0). Overweight or obesity status had an independent prevalence risk ratio for glucose impairment (2.16; 95% CI 1.39–3.36). Diabetes awareness was low (35.6%), and few individuals with diabetes were receiving biomedical treatment (33.3%). Diabetes-associated complications were common (50.2%; 95% CI 33.7–66.7), including renal (12.0%; 95% CI 4.7–27.3), ophthalmic (49.6%; 95% CI 28.6–70.7), and neurological (28.8%; 95% CI 8.0–65.1) abnormalities. Conclusions In a northern region of Tanzania, diabetes is an under-recognized health condition, despite the fact that many people either have diabetes or are at increased risk for developing diabetes. Most individuals were undiagnosed or untreated, and the prevalence of diabetes-associated complications was high. Public health efforts in this region will need to focus on reducing modifiable risk factors, which appear to include obesity, as well as early detection that includes increasing awareness. These findings highlight a growing urgency of diabetes prevention in this region as well as the need for treatment, including management of complications.

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Author and article information

Contributors

Julian T. Hertz:

ORCID: http://orcid.org/0000-0002-7396-4789

Role: ConceptualizationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing

Deng B. Madut: Role: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing

Revogatus A. Tesha: Role: Formal analysisRole: Writing – review & editing

Gwamaka William: Role: Project administrationRole: SupervisionRole: Writing – review & editing

Ryan A. Simmons: Role: Formal analysisRole: Writing – review & editing

Sophie W. Galson: Role: ConceptualizationRole: Formal analysisRole: Writing – review & editing

Francis M. Sakita: Role: Formal analysisRole: Writing – review & editing

Venance P. Maro: Role: InvestigationRole: Project administrationRole: SupervisionRole: Writing – review & editing

Gerald S. Bloomfield: Role: ConceptualizationRole: Writing – review & editing

John A. Crump:

ORCID: http://orcid.org/0000-0002-4529-102X

Role: Funding acquisitionRole: InvestigationRole: MethodologyRole: ResourcesRole: Writing – review & editing

Matthew P. Rubach: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing

Lars-Peter Kamolz: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 12 February 2019

Publication date Collection: 2019

Volume: 14

Issue: 2

Electronic Location Identifier: e0212139

Affiliations

[1 ] Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America

[2 ] Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America

[3 ] Department of Statistical Science, Duke University, Durham, North Carolina, United States of America

[4 ] Kilimanjaro Christian Medical Centre, Moshi, Tanzania

[5 ] Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America

[6 ] Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania

[7 ] Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania

[8 ] Division of Cardiology, Duke University Medical Center, Durham, North Carolina, United States of America

[9 ] Otago Global Health Institute, University of Otago, Dunedin, New Zealand

Medical University Graz, AUSTRIA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: julian.hertz@ 123456duke.edu

Author information

Julian T. Hertz http://orcid.org/0000-0002-7396-4789

John A. Crump http://orcid.org/0000-0002-4529-102X

Article

Publisher ID: PONE-D-18-35237

DOI: 10.1371/journal.pone.0212139

PMC ID: 6372176

PubMed ID: 30753216

SO-VID: 0d97566d-c42b-4fe7-be3b-740730504587

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 10 December 2018

Date accepted : 28 January 2019

Page count

Figures: 0, Tables: 4, Pages: 9

Funding

Funded by: funder-id http://data.crossref.org/fundingdata/funder/10.13039/100000865, Bill & Melinda Gates Foundation;

Award ID: OPP1158210

This study was funded by Bill & Melinda Gates Foundation ( www.gatesfoundation.org) grant OPP1158210 (Awarded to JAC). JTH and DBM received support from US National Institutes of Health Fogarty International Center grant D43TW009337; JAC from US National Institutes of Health National Institute of Allergy and Infectious Diseases (NIAID) grant R01AI121378; and MPR from US National Institutes of Health NIAID grant K23AI116869. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability All relevant data are within the manuscript and its Supporting Information files.

Perceptions of chest pain and healthcare seeking behavior for chest pain in northern Tanzania: A community-based survey

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Abstract

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Most cited references 14

Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events.

A time bomb of cardiovascular risk factors in South Africa: results from the Heart of Soweto Study "Heart Awareness Days".

Prevalence, Risk Factors, and Complications of Diabetes in the Kilimanjaro Region: A Population-Based Study from Tanzania

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