Cardiovascular Disease in Sub-Saharan Africa

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Even with the obvious worsening poor state of health care systems in most African countries, including countries like Nigeria, there is still no “visible hope” in sight that methodical plans are finally being put in place to fund more research or provide better and expanded medical care to tackle increasing incidence and prevalence of Cardiovascular Disease (CVD). CVD involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.

Anthony Mbewu and Jean-Claude Mbanya stated in “Cardiovascular Disease” (In Disease and Mortality in Sub-Saharan Africa. 2nd edition), that it is well documented that the worldwide incidence and prevalence of CVD is on the increase, especially in developing countries. The World Health Organization (WHO) estimated that 29 percent of deaths worldwide (16.7 million deaths) were due to CVD and that 43 percent of global morbidity and mortality, measured in disability-adjusted life years (DALYs), was caused by CVD (WHO 2002). “Furthermore, 78 percent of global mortality and 86 percent of mortality and morbidity from CVD occurs in developing countries. By 2020 it is estimated that CVD will become the leading cause of the global health burden, accounting for 73 percent of total global mortality and 56 percent of total morbidity.”

Mbewu and Mbanya also noted that “African countries face a double burden as they struggle to cope with the burden of communicable diseases and diseases associated with lack of socioeconomic development—the "unfinished agenda." Furthermore, their predicament is only likely to worsen, because the majority of their populations are under 35 years of age, and the determinants and risk factors for CVD are already prevalent and increasing within this age group.” In addition, they stated that “the relative cost of the epidemic of CVD is likely to be higher than in upper-income countries, where CVD primarily affects the elderly. In African countries more than half of CVD deaths occur among people between 30 and 69 years of age, an age 10 years or more below the equivalent group in Europe and North America (http://www.ichealth.org). In Ghana, for example, where cerebral hemorrhage is a leading cause of death, the average age at which people die from this cause is 55 years (http://www.ichealth.org). Death and disability in middle age have major social and economic consequences, depriving families of parents, workplaces of employees, and communities of leaders. Patients denied access to health care for CVD or deterred by high costs from seeking it will cause the public health systems to incur even greater health care costs in the long run as a result of the need to treat the same patients later at greater expense because the disease is more advanced.”

A perspective article “Lack of focus on cardiovascular disease in sub-Saharan Africa” by Ana Olga H Mocumbi (published in Cardiovascular Diagnosis and Therapy, Vol 2, No. 1, 2012) notes that “The shortage of data on the burden of cardiovascular diseases in Sub-Saharan Africa results from lack of research, which is caused by reduced local expertise and poor funding. Most international funding agencies working in this region have been devoted to investigating the major determinants of child and maternal mortality, as well as the acute aspects of endemic infectious diseases”. The article highlighted that …” As a result of progressive urbanization and westernization of lifestyle in Sub-Saharan Africa the spectrum and pattern of cardiovascular diseases along with their risk factors are changing in urban areas…Non-communicable diseases such as systemic hypertension, diabetes and coronary heart disease are increasing… the world's highest prevalence of Rheumatic heart disease (RHD) (15-20 per 1000 people) is found in sub-Saharan Africa, where the disease is the most important form of acquired cardiovascular disease in children and adolescents… Cardiomyopathies remain a challenge in Africa, particularly endomyocardial fibrosis and peripartum cardiomyopathy. Endomyocardial fibrosis affects young people and has poor prognosis, despite promising results recently achieved with the use of new surgical approaches…. Peripartum cardiomyopathy affects several thousand women and reaches an incidence of 1 per 100 deliveries in Nigeria… Cardiovascular complications of endemic infectious diseases such as Schistosomiasis, Tuberculosis, and HIV/AIDS are also important…” The article summarized that “the pattern of cardiovascular diseases in Sub-Saharan Africa is unique, including uncorrected congenital heart defects, persistence of conditions associated with poverty and infections which have not yet been controlled (rheumatic heart disease, endomyocardial fibrosis, cor pulmonale due to schistosomiasis), emergence of diseases related to changes in living habits (hypertension and stroke, ischaemic heart disease) and diseases associated to the HIV infection (tuberculous pericarditis, pulmonary hypertension, cardiomyopathy)…”

As more African government officials selfishly ensure that they and their families are flown abroad to receive proper medical care, it is more likely that improving health care systems in African nations would remain a mirage. Existing cardiology centers and required specialist trainings of medical doctors may continue to lack necessary funding, while ill-equipped cardiology units may also continue to be unable to handle more patients, especially those with more complex CVDs.

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