Cardiovascular Journal of Africa: Vol 24 No 2 (March 2013)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013 40 AFRICA
heart and coronary arteries for evidence of infarction in 23 stroke
patients in the study revealed the highest rate of myocardial
infarction (17.4%).
Observed differential mortality rates in different ethnic
groups in multiracial African communities such as South
Africans have been at least partly ascribed to different stages
of the epidemiological transition. For instance, Norman and
colleagues58 found that black Africans had approximately 60, 70
and 82% less CHD mortality rates compared to South African
Coloureds, whites and Asians, respectively.
Part of the reason for relatively high IHD mortality rates in
South African Asians is due to their high prevalence of diabetes
mellitus.59-61 By contrast, mortality from stroke in black Africans
exceeds the rates for Coloureds, whites and Asians by 2, 96 and
19%, respectively. However, mortality from hypertensive heart
disease in black South Africans was 2.5, nine and three times
higher than rates in Coloureds, whites and Asians, respectively.
Bradshaw and colleagues 62 demonstrated that IHD was the
leading cause of death among 71 641 South African men over
60 years, while it was the second most common cause of death
among the top causes of deaths in 73 474 women in the year
2000 (Table 5). In South African men aged 15 to 45 years in the
same study, IHD was ninth among the top 10 causes of death
(1.1%), although it did not feature among the top 10 causes
of death in women. HIV/AIDS was the predominant cause of
mortality in younger age groups, accounting for 40.7% of deaths
in men and 64.4% in women.
In 2005, the WHO estimated 188 000 and 173 000 deaths
from IHD in men and women, respectively in SSA.63 These
age-standardised mortality rates (ASMR) will rise by 27 and
25% in men and women, respectively by the year 2015, and by
70 and 74%, respectively by the year 2030.
Table 6 represents ASMR from IHD in selected countries
from the main regions of SSA. Despite higher ASMR in men
in mainland Africa, rates in females were close to those in men
(Table 6). In Seychelles, ASMR in men was three-fold higher
than rates in women, while Mauritius shows the highest ASMR
for IHD in both genders, with a male preponderance.
TABLE 6.AGE-STANDARDISED MORTALITY RATES FOR
ISCHAEMIC HEART DISEASE IN THEWHOAFRICA REGION, BY
SELECTED COUNTRIESAND GENDER, 2002
Region/country
Estimated
population
(millions)
Age-standardised mortality rates for
IHD (per 100 000)
Males Females
Eastern Africa
Uganda
Tanzania
Ethiopia
25.00
36.28
6.90
150
147
149
120
128
127
Central Africa
DR Congo
Rwanda
Malawi
51.20
8.27
11.87
166
149
152
132
122
125
Southern Africa
Botswana
South Africa
Mozambique
1.77
44.76
18.54
142
159
124
102
99
107
Western Africa
Nigeria
Ghana
Cameroon
120.91
20.47
15.73
160
143
154
127
114
124
Islands
Mauritius
Seychelles
1.21
0.80
277
151
161
49
DR Congo = Democratic Republic of Congo, UR Tanzania = United Republic
of Tanzania.
TABLE 7. COMPARISON OFAGE-STANDARDISED MORTALITY
RATES FOR ISCHAEMIC HEART DISEASEAND HIV/AIDS IN THE
WHOAFRICA REGION IN SELECTED COUNTRIES IN 2002
Region/country
Estimated
population
(millions)
ASMR (per 100 000) ASMR
IHD HIV/AIDS
HIV/AIDS:
IHD ratio
Eastern Africa
Uganda
UR Tanzania
25.00
36.28
270
275
555.6
593.2
2.06
2.16
Central Africa
DR Congo
Malawi
51.20
8.27
298
271
277.7
345.4
0.93
1.27
Western Africa
Nigeria
Ghana
120.91
20.47
287
257
316.8
174.6
1.10
0.66
Southern Africa
Botswana
South Africa
1.77
44.76
244
258
2,243.1
840.3
9.19
3.26
Islands
Mauritius
Seychelles
1.21
0.80
438
200
1.6
5.5
0.004
0.03
DR Congo = Democratic Republic of Congo, UR Tanzania = United Republic
of Tanzania, ASMR = age-standardised mortality rates.
Sources: WHO Global InfoBase WHO Statistical
Information System ; Mackay J, Mensah GA. The
Atlas of Heart Disease and Stroke. Geneva: World Health Organization. 2004.
TABLE 5. TOP 10 CAUSES OF MORTALITY IN SOUTHAFRICAN MENANDWOMEN > 60YEARS IN 2000
Cause of death
Percentage (%) in males
aged > 60 years
[n = 71 641] Cause of death
Percentage (%) in females
aged > 60 years
[n = 73 474]
Ischaemic heart disease 17.2 Stroke 17.7
Stroke 12.2 Ischaemic heart disease 16.0
COPD 8.0 Hypertensive heart disease 9.8
Tuberculosis 6.4 Diabetes mellitus 7.3
Lower respiratory tract infection 5.1 Lower respiratory tract infection 5.3
Hypertensive heart disease 4.2 COPD 4.4
Cancer of airways 4.1 Nephritis 2.8
Diabetes mellitus 4.0 Tuberculosis 2.7
Cancer of prostate 3.1 Asthma 2.4
Cancer of oesophagus 2.8 Cancer of the breast 1.9
COPD = chronic obstructive pulmonary disease.