Cocoa is a major dietary source of polyphenols, including flavanols, which have been associated with reduced blood pressure (BP). While earlier systematic reviews and meta-analyses have shown significant effects of cocoa consumption on systolic BP, limitations include small sample sizes and study heterogeneity. Questions regarding food matrix and dose of polyphenols, flavanols, or epicatechins remain. This systematic review and meta-analysis aimed to investigate the effects of ≥2 weeks of cocoa consumption as a beverage or dark chocolate in those with normal or elevated (< or ≥130 mmHg) systolic BP measured in the fasted state or over 24-h. A systematic search conducted on PubMed and Cochrane Library databases up to 26 February 2022 yielded 31 suitable articles. Independent of baseline BP, cocoa consumption for ≥2 weeks was associated with reductions in systolic and diastolic BP (p < 0.05, all). Compared with cocoa, chocolate lowered the weighted mean of resting systolic BP (−3.94 mmHg, 95% CI [−5.71, −2.18]) more than cocoa beverage (−1.54 mmHg, 95% CI [−3.08, 0.01]). When the daily dose of flavanols was ≥900 mg or of epicatechin ≥100 mg, the effect was greater. Future, adequately powered studies are required to determine the optimal dose for a clinically significant effect.

Background: In high-income countries, mortality related to hospitalized patients with the Coronavirus disease 2019 (COVID-19) is approximately 4-5%. However, data on COVID-19 admissions from sub-Saharan Africa are scanty.Objective: To describe the clinical profile and determinants of outcomes of patients with confirmed COVID-19 admitted at a hospital in Ghana.Methods: A prospective study involving 25 patients with real time polymerase chain reaction confirmed COVID-19 admitted to the treatment centre of the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana from 1st June to 27th July, 2020. They were managed and followed up for outcomes. Data were analysed descriptively, and predictors of mortality assessed using a multivariate logistic regression modelling.Results: The mean age of the patients was 59.3 ± 20.6 years, and 14 (56%) were males. The main symptoms at presentation were breathlessness (68%) followed by fever (56%). The cases were categorized as mild (6), moderate (6), severe (10) and critical (3). Hypertension was the commonest comorbidity present in 72% of patients. Medications used in patient management included dexamethasone (68%), azithromycin (96%), and hydroxychloroquine (4%). Five of 25 cases died (Case fatality ratio 20%). Increasing age and high systolic blood pressure were associated with mortality.Conclusion: Case fatality in this sample of hospitalized COVID-19 patients was high. Thorough clinical assessment, severity stratification, aggressive management of underlying co-morbidities and standardized protocols incountry might improve outcomes.

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

Background: Carers of people with dementia (PWD) face a myriad of challenges. As dementia prevalence surges in the sub-Saharan population, the provision of data on the met and unmet needs of caregivers has become paramount. Aim: This study aimed to identify the needs of carers of older adults living with dementia in Ghana. Setting: This study was conducted in Kumasi, Ghana, among participants ≥ 18 years old, serving as carers for PWD. Methods: This was a multicentre cross-sectional study involving carers of patients (≥ 50 years) with dementia. The authors administered the Carer’s Needs Assessment for Dementia (CNA-D) questionnaire, containing 18 problem areas with interventions for each problem area. Pearson’s correlation analysis was performed to establish a relationship between demographic characteristics, problem areas and intervention score. Results: Fifty participants were recruited with a mean age of 48.8 (± 16.9) years, 72.0% were female participants and 98.0% were family members of PWD. The problem area most frequently identified as no/mild problem was ‘legal issues’ (92.0%, n = 46), and ‘lack of information about dementia’ was assessed as severe (48.0%, n = 24). The commonest unmet need was ‘printed information material’ (84.0%, n = 42), and the commonest met need was ‘diagnosis and treatment of carer by a general practitioner’ (42.0%, n = 21). There was a statistically negative correlation between age of carer and number of unmet needs (r = −0.308, p = 0.011) and a positive correlation between problem area score and number of unmet needs (r = 0.308, p = 0.030). Conclusion: Effective public education and provision of information on dementia to carers are essential interventions needed to equip them in performing their roles. Contribution: Carers in this study revealed that they lacked information on dementia but their commonest met need was accessibility to their general practitioner. This highlights the importance of promoting knowledge and awareness of dementia among primary care practitioners.

Cocoa beverage and dark chocolate are important dietary sources of polyphenol and have been hypothesised to improve the lipid profile. This systematic review and meta-analysis aimed to investigate the effect of cocoa beverage and dark chocolate intake on lipid profile in individuals living with normal and elevated LDL cholesterol. The question on whether cocoa beverage and chocolate differentially modify the lipid profile was also explored. A systematic literature search was conducted on PubMed and Cochrane Library on 26 February 2022 following the PRISMA guideline. Cocoa beverage and chocolate consumption had no significant effect on circulating concentrations of total cholesterol, LDL cholesterol, and triglycerides (p > 0.05, all), but favourably and significantly increased circulating concentration of HDL cholesterol by 0.05 (95% CI [0.02, 0.09]) mmol/L (p = 0.002). Changes in lipid profile were similar when comparing populations with normal vs. elevated LDL cholesterol (p > 0.05, all). When considering the food matrix, cocoa beverage intake significantly increased HDL cholesterol by 0.11 (95% CI [0.06, 0.17]) mmol/L (p < 0.001), but the improvement in HDL cholesterol was not significant when chocolate (p = 0.10) or a combination of cocoa beverage and chocolate (p = 0.19) (subgroup differences, p = 0.03) was administered. Cocoa consumption could be recommended as part of a healthy diet in the general population with normal and elevated LDL cholesterol.

Gait speed is an essential predictor of functional and cognitive decline in older adults. The study aimed to investigate the gait speed of older adults in Ghana and South Africa and to determine its associated factors, as the Sub-Saharan representatives in the World Health Organization’s Study on Global AGEing in Older Adults (SAGE). A secondary analysis of data from the SAGE study which consists of nationally representative data involving participants aged ≥50+ years with smaller samples of younger adults aged 18–49 years in Ghana and South Africa was conducted. SAGE study employed a multistage, stratified clustered sample design and involved the use of a standardised questionnaire to obtain participants’ (n = 5808) demographic, anthropometric and gait speed information. The standard 4 metre-gait speed was used. Median gait speed for the study group, which comprised African/Black participants aged ≥50+ years was 0.769(Q1 = 0.571, Q3 = 0.952)m/s for males and 0.667 (Q1 = 0.500,Q3 = 0.833)m/s for females. For every unit increase in age, the odds of being in a higher-ranked gait speed category was 0.96(95%CI 0·96, 0·97, p<0.001) times that of the previous age. Females had odds of 0.55 (95%CI 0.50, 0.61, p<0.001) of recording higher gait speed, as compared to males. Rural dwellers had odds of 1.43 (95%CI 1.29, 1.58, p < 0.001) of being in a higher-ranked category of gait speed compared to urban dwellers. Underweight (OR = 0.85, 95%C1 = 0.73–1.00, p<0.05) and obesity (OR = 0.53, 95%CI = 0.46–0.61, p<0.001) were associated with slower gait speed. Amongst functional indices, the World Health Organization Disability Assessment Schedule (WHODAS) score was the biggest determinant of gait speed. Having a “Severe/Extreme” WHODAS score had the strongest association with gait speed (OR = 0.18, 95%CI = 0.14–0.23, p<0.001). These gait speed results provide an essential reference for older adults’ care in Ghana and South Africa.