CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011
AFRICA
191
Review Article
The state of heart disease in Sudan
A SULIMAN
Abstract
Cardiovascular disease (CVD) is the leading cause of mortal-
ity worldwide and an important cause of disability. InAfrica,
the burden of CVD is increasing rapidly and it is now a
public health concern. Epidemiological data on diseases is
scarce and fragmented on the continent.
Aim
: To review available data on the epidemiology and
pattern of heart disease in Sudan.
Methods
: Data were obtained from the Sudan Household
Survey (SHHS) 2006, annual health statistical reports of the
Sudan Federal Ministry of Health, the STEPS survey of
chronic disease risk factors in Sudan/Khartoum, and journal
publications.
Results
: The SHHS reported a prevalence of 2.5% for heart
disease. Hypertensive heart disease (HHD), rheumatic heart
disease (RHD), ischaemic heart disease (IHD) and cardio-
myopathy constitute more than 80% of CVD in Sudan.
Hypertension (HTN) had a prevalence of 20.1 and 20.4%
in the SHHS and STEPS survey, respectively. There were
poor control rates and a high prevalence of target-organ
damage in the local studies. RHD prevalence data were
available only for Khartoum state and the incidence has
dropped from 3/1 000 people in the 1980s to 0.3% in 2003.
There were no data on any other states. The coronary event
rates in 1989 were 112/100 000 people, with a total mortal-
ity of 36/100 000. Prevalence rates of low physical activity,
obesity, HTN, hypercholesterolaemia, diabetes and smoking
were 86.8, 53.9, 23.6, 19.8, 19.2 and 12%, respectively, in the
STEPS survey. Peripartum cardiomyopathy occurs at a rate
of 1.5% of all deliveries. Congenital heart disease is prevalent
in 0.2% of children.
Conclusion
: Heart diseases are an important cause of morbid-
ity and mortality in Sudan. The tetrad of hypertension,
RHD, IHD and cardiomyopathy constitute the bulk of CVD.
Hypertension is prevalent, with poor control rates. A decline
in rheumatic heart disease was seen in the capital state and
no data were available on other parts of the country. No
recent data on IHD were available. Peripartum cardiomyo-
pathy and congenital heart disease occur at similar rates to
those in other African countries.
Keywords:
Sudan, prevalence, epidemiology, heart disease,
pattern of heart disease, hypertensive heart disease, rheumatic
heart disease, ischaemic heart disease, cardiomyopathy
Submitted 29/3/10, accepted 1/7/10
Cardiovasc J Afr
2011;
22
: 191–196
DOI: 10.5830/CVJA–2010–054
Sudan is the largest country in Africa and the ninth largest in
the world, with an area of about one million square miles. It has
a population of more than 39 million people, comprising tribes
that descended from African, Arab and Nubian origins.
1,2
Sudan
is geographically unique, lying in the north-east corner of the
continent, extending from latitude 22° north to 3° south, with the
northern part of the country in the Saharan belt and the central
and southern parts in the sub-Saharan region.
1
Worldwide, cardiovascular disease (CVD) is responsible
for 30% of all deaths and 10% of DALYs (disability-adjusted
life years).
3
In Africa, the burden of cardiovascular disease is
increasing rapidly and it is now a public health concern. It has a
major socio-economic impact on individuals, families and socie-
ties in terms of healthcare costs, work absenteeism and national
productivity. The most important cardiovascular diseases in the
African region are those related to hypertension, atherosclerosis,
cardiomyopathies and rheumatic heart disease.
4,5
In Sudan, like many other less-developed countries, particu-
larly in sub-Saharan Africa, epidemiological data on diseases are
scarce and fragmented.
6
Most of the data on disease burden for
sub-Saharan Africa come from extrapolations, as in the Global
Burden of Disease Study (GBDS),
7
which relies on cause-of-
death models and expert opinion.
In this article, we aim to review available epidemiological data
on the burden of cardiovascular disease and its pattern in Sudan,
as well as the prevalence of individual cardiac diseases, namely
hypertensive, rheumatic and atherosclerotic heart diseases and
their risk factors, cardiomyopathies, particularly peripartum and
dilated cardiomyopathy, and congenital heart diseases.
We reviewed data from annual health statistical reports
8
issued
by the Federal Ministry of Health, the Sudan Household Survey
(SHHS) of 2006,
9
World Health Organisation STEPS (STEPwise
approach to Surveillance) data,
10
published data using Medline
search, with the terms ‘cardiovascular disease Sudan’, ‘heart
disease Sudan’, ‘hypertensive heart disease Sudan’ and ‘cardio-
myopathy Sudan’, and unpublished data on relevant topics.
These were compared to similar data from other countries in the
continent and worldwide, as well as estimates from the World
Health Organisation (WHO) and the Global Burden of Disease
Study.
11
Burden of cardiovascular disease in Sudan
The only epidemiological data on the prevalence of cardiovascu-
lar disease in the community come from the SHHS.
9
This survey
Department of Medicine, Faculty of Medicine, University of
Khartoum, Khartoum, Sudan
A SULIMAN, MBBS, FACP,
;
