CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011
192
AFRICA
of 2006 was a questionnaire-based survey in all states of Sudan,
organised by the Federal Ministry of Health and Ministry of
Health of the Government of southern Sudan; 24 527 households
and more than 55 000 Sudanese were surveyed. The self-report-
ed prevalence of heart disease was 2.5%. This figure remains
low compared to developed countries.
12
Fig. 1 shows prevalence
of cardiovascular disease compared to other non-communicable
diseases in the SHHS.
The Federal Ministry of Health issues an annual health statis-
tical report that includes data on causes of hospital mortality.
Over the past decade, cardiovascular disease has been consist-
ently reported in the top 10 causes of hospital mortality, with
malaria and acute respiratory infections as the first two causes.
Fig. 2 demonstrates the contribution of cardiovascular disease,
malaria, respiratory tract infections, diabetes mellitus (DM) and
hypertension to hospital mortality in Sudan from 1998 to 2008.
Such a significant contribution of cardiovascular disease to
mortality is also seen in other African countries.
13,14
Pattern of heart disease in Sudan
In 1937, an analysis was made of 100 consecutive cases of heart
disease admitted to Khartoum Hospital: 80 had cardiovascular
syphilis, followed by rheumatic heart disease. There was no
mention of ischaemic heart disease.
In 1961 the same author, Dr Halim, analysed 958 consecutive
cardiac cases admitted to Khartoum Hospital. Hypertension and
rheumatic heart disease (RHD) were the commonest two diag-
noses at 44.4 and 25.4% of the sample, respectively. Ischaemic
heart disease (IHD) was 12.6 % and syphilitic heart disease
regressed to 6.0%.
15
Table 1 summarises the result of that study.
Two other similar studies investigating the pattern of heart
disease were conducted in the 1980s and 1990s. The first
study conducted by Khalil
et al
. was in a community hospital
in Khartoum North Hospital and included 539 patients from
1980 to 1983.
16
The other was performed in 1992 in Al Shaab
Hospital, which is a tertiary referral hospital, by Kurdufani
et
al
. and included 1 000 patients. Unfortunately, the latter study
was unpublished and data were obtained directly from the author.
Table 2 summarises the main findings from these two studies.
They show that the tetrad of hypertensive heart disease, rheu-
matic heart disease, ischaemic heart disease and cardiomyopathy
are the main cardiovascular causes for hospital admission. These
results are comparable to the recent Heart of Soweto study,
17
which also showed that these four disease categories, together
with pericardial disease, are the main cardiac causes for hospital
presentation in Soweto, South Africa.
The contribution of HIV/AIDS to heart disease in Sudan,
particularly cardiomyopathy and pericardial disease is unclear.
However, this is expected to be less than what is seen in many
parts of sub-Saharan Africa, as Sudan has one of the lowest HIV
prevalence rates in this region. HIV prevalence rate for adults
aged 15 to 49 in Sudan is 1.4% (1–2%),
18
compared to 5.2% for
sub-Saharan Africa in 2008.
19
Hypertensive heart disease
Hospital-based surveys in Sudan dating back from the middle
of the last century have shown that hypertensive heart disease,
particularly with its contribution to heart failure, is probably
the commonest cause of cardiovascular disease.
15,16
This can be
explained by a number of factors, including high prevalence rates
TABLE 2. SUMMARY OF RECENT PATTERN OF HEART
DISEASE STUDIES IN SUDAN
16
Study (hospital, year)
RHD
(%)
HHD
(%)
IHD
(%)
Cardio-
myopahty
(%)
CHD
(%)
Other
(%)
Khalil
et al
.
(Khartoum North
Hospital, 1980–1983)
26.5 33.7 17.8 4.8
3.9 13.3
Kurdufani
et al
.
(AlShaab Hospital,
1992)
30.0 12.0 32.0 6.0
2.0 18.0
RHD, rheumatic heart disease; HHD, hypertensive heart disease; IHD
ishaemic heart disease; CHD, congenital heart disease.
TABLE 1. ANALYSIS OF 958 CARDIAC CASES INVESTIGATED
IN KHARTOUM DURINGTHEYEARS 1957–1960
15
Cardiac
disorder
Congen-
ital
SA HTN IHD PHD EMF RHD
Miscel-
laneous
5 of total
3.7 6.0 44.4 12.6 2.0 3.2 25.4 2.7
SA, syphilitic aortitis; HTN, hypertension; IHD, ischaemic heart disease;
PHD, pulmonary heart disease; EMF, endomyocardial fibrosis; RHD,
rheumatic heart disease.
Fig. 1. Prevalence of cardiovascular diseases, hyperten-
sion, diabetes mellitus, cancer, cataract and mental disor-
ders in SHHS.
9
CVD, cardiovascular disease; HTN, hyper-
tension; DM, diabetes mellitus; SHHS, Sudan Household
survey. Available at
25
20
15
10
5
0
HTN DM Cataract Mental
disorders
CVD Cancer
% of population
20.1
12.7
5.5
2.8
2.5
0.2
Fig. 2. Hospital mortality of cardiovascular diseases,
hypertension, diabetes mellitus, malaria and respiratory
tract infections in Sudan 1998–2008. CVD, cardiovascular
disease; HTN, hypertension; DM, diabetes mellitus; RTI,
respiratory tract infection. Adapted from annual health
statistical reports of the Federal Minsitry of Health.
10
Available at
25
20
15
10
5
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
% of total mortality
Year
CVD
Malaria
RTI
HTN
DM
