Pilly Chillo | Muhimbili University of Health and Allied Sciences (MUHAS) (original) (raw)

Papers by Pilly Chillo

Frontiers in Cardiovascular Medicine

IntroductionDespite advances in diagnostic and treatment, morbidity and mortality due to infectiv... more IntroductionDespite advances in diagnostic and treatment, morbidity and mortality due to infective endocarditis (IE) has not decreased. There is a discrepancy in epidemiology of IE between developed and developing countries. Over the last years, increased early detection and consequently prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) which are considered predisposing conditions for IE, is noted. Here, we present a review of literature on IE in developing countries.MethodsWe conducted a systematic literature search of IE studies in developing countries through PubMed and Embase. We have divided the studies into two groups: studies published before 2015 (group 1) and studies ≥ 2015 (group 2). The outcome was defined as a difference in epidemiology, microbiology, treatment, and mortality over time. The Scale for Assessment of Narrative Review Articles guidelines was applied.FindingsIn total, 16 studies were included. The total number of IE cases was 1,09...

BMJ Open, 2021

IntroductionThe paucity of data describing cardiovascular disease (CVD) in pregnancy in many part... more IntroductionThe paucity of data describing cardiovascular disease (CVD) in pregnancy in many parts of Africa including Tanzania has given rise to challenges in proper management by the healthcare providers. This study is set out to (1) determine the prevalence of a range of CVDs during pregnancy in women attending antenatal clinics in Tanzania and (2) determine the impact of these CVDs on maternal and fetal outcomes at delivery.Methods and analysisThis is a cross-sectional study with a prospective component to be conducted in two referral hospitals in Tanzania. Pregnant women aged ≥18 years diagnosed with a CVD during the antenatal period are being identified and extensively characterised by performing clinical assessment, modified WHO staging, electrocardiography, echocardiography and laboratory tests. Patients identified with CVDs (exposed) and a subset without (unexposed) will be followed up to determine maternal and fetal outcomes at delivery. A minimum sample of 1560 will be su...

Journal of Clinical and Diagnostic Research, 2021

Introduction: Heart Failure (HF) is a global health problem, and despite much progress in new the... more Introduction: Heart Failure (HF) is a global health problem, and despite much progress in new therapies, its prognosis remains poor. This is due to a number of factors including lack of adherence to HF medications. Previous studies have shown high sensitivity C-reactive protein (hsCRP) to change with HF progression, and that plasma hsCRP levels can be used to predict HF progression and assessment of adherence to medications. This association however has not been studied in Sub-Saharan African (SSA) countries, including Tanzania. Aim: To study the association between hsCRP levels and HF medications adherence among HF patients attending the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania. Materials and Methods: This was a hospital based cross-sectional study, where all eligible adult HF patients were consecutively enrolled as they attended their regular clinics, until the sample size was reached. Patients’ socio-demographic and clinical information was collected thr...

European Journal of Clinical Investigation, 2020

Background The epidemiology and management of diseases can be influenced by social demographic fa... more Background The epidemiology and management of diseases can be influenced by social demographic factors. Gender and migration are among these factors. Methods We aimed at reviewing the impacts of gender and migration on Rheumatic heart disease (RHD) epidemiology and management by a non-systematic literature review of published studies on RHD worldwide. Our PubMed search terms included RHD pathophysiology, diagnosis, complications, management or prevention, combined with words 'rheumatic mitral stenosis (MS)', 'outcomes after percutaneous balloon mitral valvuloplasty (PBMV)', 'gender or sex difference', and 'migration'. The reporting of this study conforms to SANRA (the Scale for Assessment of Narrative Review Articles) guidelines. Results We retrieved eight studies about the impact of sex on outcomes after PBMV. All of these studies showed a female predominance for RHD. Two studies showed that there is no impact, three studies showed female sex as a predictor of poor outcomes, and the other three showed male sex a predictor of poor outcomes. Although RHD is reported to be eradicated in the developed countries, 2.1% of refugees recently screened for RHD in Italy were found to have subclinical RHD. This prevalence is similar to those found in India (2.0%), Cambodia (2.2%), and Mozambique (3%). Conclusions There are contradicting results for outcomes after PBMV between males and females. It is not clear whether sex difference plays a role in pathophysiology, diagnosis, management and prognosis of MS. Migration has impacts on epidemiology and management of RHD. Further studies are required in these two fields to explore their relationship to RHD.

Pan African Medical Journal, 2021

Introduction: contrast media are increasingly used in diagnostic and interventional procedures bu... more Introduction: contrast media are increasingly used in diagnostic and interventional procedures but are also known causes of acute kidney injury-a condition known as contrast induced nephropathy (CIN). We aimed to determine the magnitude and associated factors of CIN among patients undergoing coronary angiography and percutaneous coronary intervention at a cardiac referral hospital in Tanzania. Methods: all adult patients undergoing elective coronary angiography and percutaneous coronary intervention at Jakaya Kikwete Cardiac Institute were consecutively enrolled between August 2017 and January 2018, if they fulfilled the inclusion criteria. Pre-procedure, 24-and 72-hours' post procedure serum creatinine was measured. CIN was defined as increase of ≥25% or absolute increase of ≥44μmol/L of serum creatinine within 72 hours following exposure to contrast media. Data analysis were done using SPSS Version 20. P-value of <0.05 was considered statistically significant. Results: in total, 210 (94.6%) out of 222 patients seen during the study period fulfilled the inclusion criteria and were enrolled. Their mean (SD) age was 61.3 (10.9) years and 64.3% were men. Hypertension, diabetes, smoking and alcohol consumption was present in 86.7%, 37.7%, 12.4% and 37.6% respectively. The incidence of CIN was 19% within 72 hours post procedure. On multivariate logistic regression analysis, independent factors for developing CIN were history of heart failure (aOR=7.34), central obesity (aOR=3.12), triple vessel disease (aOR=10.14) and post procedure stay of ≥3 days (aOR=4.1), all p<0.05. Conclusion: the incidence of CIN found in this population is high (19%) and is associated with heart failure, obesity, multi-vessel disease and longer postprocedure hospital stay.

Frontiers in Cardiovascular Medicine, Mar 25, 2022

Introduction: Cardiovascular disease (CVD) contribute the largest mortality burden globally, with... more Introduction: Cardiovascular disease (CVD) contribute the largest mortality burden globally, with most of the deaths (80% of all deaths) occurring in low and middle-income countries (LMICs), including Tanzania. Despite the increasing burden, to date, CVD research output is still limited in Tanzania, as it is for many sub-Saharan Africa (SSA) countries. This trend hinders the establishment of locally informed CVD management and policy changes. Here, we aim to review the existing gaps while highlighting the available opportunities for a sustainable CVD research strategy in Tanzania. Methods: A rapid review of available literature on CVD research in SSA was conducted, with emphasis on the contribution of Tanzania in the world literature of CVD. Through available literature, we identify strategic CVD research priorities in Tanzania and highlight challenges and opportunities for sustainable CVD research output. Findings: Shortage of skilled researchers, inadequate research infrastructure, limited funding, and lack of organized research strategies at different levels (regional, country, and institutional) are among the existing key bottlenecks contributing to the low output of CVD research in Tanzania. There is generally strong global, regional and local political will to address the CVD epidemic. The establishment of the East African Centre of Excellence in Cardiovascular Sciences (EACoECVS) offers a unique opportunity for setting strategies and coordinating CVD research and training for Tanzania and the East African region.

BMJ Open, 2022

BackgroundGiven that vitamin K-dependent anticoagulants (VKAs) will continue to be the primary an... more BackgroundGiven that vitamin K-dependent anticoagulants (VKAs) will continue to be the primary anticoagulant in Africa for a long time, understanding the quality of anticoagulation services in the continent is vital for optimising the intended benefits. Notably, a few small studies have assessed the quality of anticoagulation in sub-Saharan Africa (SSA) countries. This study will describe the current VKA use and anticoagulation control among patients in selected SSA countries.Methods and analysisWe plan to review the 2019 anticoagulation data of a cohort of 800 random patients from 19 selected clinics in Botswana, the Democratic Republic of Congo, Ethiopia, Gambia, Ghana, Mozambique, Nigeria, Tanzania and South Africa. We expect at least one participating site to enrol 100 participants in each country. Eligible participants will be those on VKAs for at least 3 months and with at least four international normalised ratio (INR) results. We will document the indications, type and durat...

once known as diseases of the Western world have recently been emerged as diseases of public heal... more once known as diseases of the Western world have recently been emerged as diseases of public health importance in many developing countries. Change in life style and socio- economic status associated with urbanization is thought to be the major contributing factor for this trend. In its message to the developing countries, the World Health Organization has urged for a prompt control of cardiovascular diseases at an early stage before the burden becomes more severe. The need for Primordial Prevention has highly been recommended. To determine the prevalence, awareness and knowledge of the conventional cardiovascular risk factors among primary school children aged 6 - 15 years in Urban Dar es Salaam and Rural Morogoro. Cross sectional survey of children aged 6 - 15 years from four primary schools in Urban Dar es Salaam and two primary schools in Rural Morogoro. Anthropometric and Blood Pressure measurements were done using the standard techniques, blood samples taken and analysed for s...

International Journal of Nephrology and Renovascular Disease

Background: Hypertensive retinopathy is a known marker of cardiovascular disease, and among unsel... more Background: Hypertensive retinopathy is a known marker of cardiovascular disease, and among unselected patients with chronic kidney disease (CKD) more severe retinopathy has been associated with lower estimated glomerular filtration rate (eGFR). This association has, however, not been widely studied among nondiabetic hypertensive patients with CKD, especially in sub-Saharan Africa. We aimed to determine the prevalence and severity of hypertensive retinopathy and its relationship with eGFR among nondiabetic CKD patients seen at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: A hospital-based cross-sectional study was conducted among nondiabetic CKD adult (≥18 years) patients with hypertension. A structured questionnaire was used to record patients' demographic characteristics and their cardiovascular risk profile. eGFR was calculated using the Modification of Diet in the Renal Disease (MDRD) equation and only patients with CKD stage 3 or more were enrolled in the study. Grading of retinopathy was done using the Keith-Wagener classification. Results: In total, 224 patients fulfilled the inclusion criteria and were enrolled. Their mean age was 45.8±14.1 years, and 59.4% were men. The proportions of patients with stage 3, 4, and 5 CKD were 21.4%, 19.6%, and 58.9%, respectively. Hypertensive retinopathy was present in 157 (70.1%) patients and the proportions with grade I, grade II, grade III, and grade IV retinopathy were 17.9%, 18.8%, 19.6%, and 13.8%, respectively. The severity of retinopathy increased with decreasing levels of eGFR, and in multivariate logistic regression analysis, factors found to be independently associated with ≥grade II hypertensive retinopathy were more severe CKD, higher hypertension grades, and alcohol use, all p<0.05. Conclusion: The prevalence of hypertensive retinopathy is high among nondiabetic CKD patients seen at a tertiary hospital in Tanzania and is independently associated with CKD severity. Retinopathy grade can be used as a marker of CKD severity among these patients.

BACKGROUND Cardiomyopathies, defined as diseases involving mainly the heart muscle, are linked to... more BACKGROUND Cardiomyopathies, defined as diseases involving mainly the heart muscle, are linked to 5.9 of 100,000 of estimated mortality of the global population although underdiagnosis is significant. In sub Saharan Africa, studies show that cardiomyopathy constitutes 21.4% of cases with heart failure and comes second only to hypertensive heart disease. However, there is paucity of data in the region regarding the different types of cardiomyopathies. It has been noted that presence of non-modifiable cardiovascular risk factors such as family history, age, ethnicity, gender as well as modifiable risk factors such as hypertension, diabetes, tobacco use, physical inactivity, poor nutrition, excessive alcohol consumption, high cholesterol and obesity increase the probability of developing cardiovascular disease. OBJECTIVE The review will focus on available literature in sub- Saharan Africa on prevalence of dilated cardiomyopathy (DCM) and associated risk factors in patients with DCM. It...

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, Jan 29, 2016

Stroke is a major cause of death worldwide and 85.5% of stroke deaths occur in low- and middle-in... more Stroke is a major cause of death worldwide and 85.5% of stroke deaths occur in low- and middle-income countries due to stroke. The aim of this study was to investigate correlates and predictors of 30-day mortality in stroke patients in urban Tanzania. A prospective 30-day follow-up study was conducted at the Muhimbili National Hospital, Dar es Salaam, Tanzania. We recruited all patients with stroke seen at the Emergency Medicine Department and medical wards. Patients underwent medical history and physical examination including full neurological examination. For those who met the criteria for the diagnosis of stroke according to the World Health Organization, further data were collected, including cholesterol, creatinine, fasting blood glucose, full blood picture, human immunodeficiency virus serology, and electrocardiogram. Patients were followed up at 30 days from the date of stroke onset. The date and the cause of death of those participants who died within 30 days of stroke onset...

Tanzania Journal of Health Research, 2013

Cardiovascular diseases, including heart failure are a known complication of Human Immunodeficien... more Cardiovascular diseases, including heart failure are a known complication of Human Immunodeficiency Virus (HIV) infection globally. The objective of this study was to describe factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania. Clinical, laboratory and echocardiographic assessment was performed in all HIV-infected patients presenting with cardiac complaints at the medical department, Muhimbili National Hospital between September 2009 and April 2010. HF was diagnosed clinically and confirmed by echocardiography. Of the 102 HIV-infected patients with cardiac complaints 50 (49%) were in HF. Commonest causes of HF were hypertensive heart disease, pulmonary hypertension and dilated cardiomyopathy. In multivariate analysis male gender (OR 4.03), low education (OR 4.91), previous history of tuberculosis (OR 3.01), and low haemoglobin (OR 0.83), were independently associated with the diagnosis of HF (p<0.05 for all). In conclusion, heart failure is common in HIV-infected patients with cardiac complaints, and is associated with both modifiable and non-modifiable factors.

Cardiovascular Journal Of Africa, 2012

Objective: To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in ... more Objective: To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: Echocardiography was performed in 61 type 1 and 123 type 2 diabetes patients. LV hypertrophy was taken as LV mass/height 2.7 > 49.2 g/m 2.7 in men and > 46.7 g/m 2.7 in women. Relative wall thickness (RWT) was calculated as the ratio of LV posterior wall thickness to end-diastolic radius and considered increased if ≥ 0.43. LV geometry was defined from LV mass index and RWT in combination. Results: The most common abnormal LV geometries were concentric remodelling in type 1 (30%) and concentric hypertrophy in type 2 (36.7%) diabetes patients. Overall, increased RWT was present in 58% of the patients. In multivariate analyses, higher RWT was independently associated with hypertension, longer isovolumic relaxation time, lower stress-corrected midwall shortening and circumferential endsystolic stress, both in type 1 (multiple R 2 = 0.73) and type 2 diabetes patients (multiple R 2 = 0.66), both p < 0.001. These associations were independent of gender, LV hypertrophy or renal dysfunction. Conclusion: Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.

Pan African Medical Journal, 2014

Introduction: excess body fat and high blood pressure (BP) are important risk factors for increas... more Introduction: excess body fat and high blood pressure (BP) are important risk factors for increased cardiovascular morbidity and mortality, and both may have their roots of occurrence in childhood and adolescence. The present study aimed at determining the association between body fat composition and BP level among adolescents in Tanzania. Methods: a cross-sectional study involving 5 randomly selected secondary schools within Dar es Salaam was conducted between June and November 2013. Structured questionnaires were used to collect information on demographic characteristics and other cardiovascular risk factors. BP, height, weight and waist circumference were measured following standard methods. Body fat was assessed by skinfold thickness and categorized as underfat, healthy, overfat or obese according to World Health Organization definitions. Hypertension was defined as BP ≥ 90 th percentile for age, height and gender of the adolescent. Results: the study included 582 adolescents (mean age 16.5±1.8 years, 52.1% boys). The proportion of adolescents with overfat or obesity was 22.2%. Systolic, diastolic and combined hypertension was present in 17.5%, 5.5%, and 4.0% respectively. In the total population mean body fat percent correlated positively with diastolic BP and mean arterial pressure (MAP) but not with systolic BP. In multivariate analysis body mass index (β=0.21, p=0.008) and waist circumference (β=0.12, p=0.049), but not body fat percentage (β=-0.09, p=0.399) independently predicted higher MAP. Conclusion: body mass index predicts BP level better than body fat composition and should be used as a measure of increased risk for hypertension among adolescents.

Global Heart, 2014

The concept of cardiac critical care is emerging as a tool in the management of cardiovascular di... more The concept of cardiac critical care is emerging as a tool in the management of cardiovascular diseases in many Sub-Saharan African countries. The region is undergoing significant epidemiological transition. There remains a significant burden of infectious and nutritional disease, but cardiovascular disease, notably hypertension and coronary artery disease, as well as other noncommunicable diseases (NCD) are emerging rapidly, placing a double burden on existing healthcare systems. Within this complex, heterogeneous, and changing epidemiologic setting, efforts to diagnose and treat cardiovascular diseases have increased. As more patients are diagnosed with acute cardiac conditions, the number requiring management in a cardiac critical care unit is also increasing. In this review, using the Tanzanian experience, we attempt to chronicle the appearance of cardiac critical care services and the many challenges to their implementation in a resource-limited environment.

Cardiovascular Journal of Africa, 2012

Objective: To determine the pattern of echocardiographic diagnoses in HIV-infected patients prese... more Objective: To determine the pattern of echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: Patients known to be HIV positive and with cardiac complaints were prospectively recruited from the Hospital's care and treatment centre as well as from the medical wards. Clinical assessment, laboratory tests and echocardiography were performed. Results: A total of 102 patients were recruited from September 2009 to April 2010. The patients' mean age was 42.4 years and 68.6% were women. The most common diagnosis was pericardial effusion present in 41.2% of the patients. The effusion was large in 5.9% and small in 35.3% of the patients. Hypertensive heart disease was diagnosed in 34.3%, while pulmonary hypertension and dilated cardiomyopathy were present in 12.7 and 9.8%, respectively. Conclusion: Cardiac abnormalities are common in HIV-infected patients, particularly when they present with symptoms.