Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015

AFRICA

Faculty of Health Sciences and Technology, University of

Nigeria, Enugu Campus, Enugu State, Nigeria

Department of Medicine, Federal Medical Centre, Abeokuta,

Nigeria

Hatter Institute for Cardiovascular Research in Africa and

Institute of Infectious Disease; and Molecular Medicine,

Faculty of Health Sciences, University of Cape Town, Cape

Town, South Africa

Introduction:

Heart failure (HF) is a deadly, disabling and often

costly syndrome worldwide. Unfortunately, there is a paucity

of data describing its economic impact in sub-Saharan Africa;

a region in which the number of relatively younger cases will

inevitably rise.

Methods:

Heath economic data were extracted from a prospec-

tive HF registry in a tertiary hospital situated in Abeokuta,

south-west Nigeria. Out-patient and in-patient costs were

computed from a representative cohort of 239 HF cases includ-

ing personnel, diagnostic and treatment resources used for their

management over a 12-month period. Indirect costs were also

calculated. The annual cost per person was then calculated.

Results:

Mean age of the cohort was 58.0

15.1 years and

53.1% were men. The total computed cost of care for HF in

Abeokuta was 76 288 845 Nigerian Naira (US$508 595), trans-

lating to 319 200 Naira (US$2 128) per patient per year. The

total cost of in-patient care (46% of total healthcare expendi-

ture) was estimated at 34 996 477 Naira (about US$301 230).

This comprised 17 899 977 Naira (50.9%; US$114 600) and

17 806 500 Naira (49.1%; US$118 710) for direct and indirect

costs, respectively. Out-patient cost was estimated as 41 292 368

Naira (US$275282). The relatively high cost of out-patient care

was largely due to cost of transportation for monthly follow-

up visits. Payments were mostly made through out-of-pocket

spending.

Conclusion:

The economic burden of HF in Nigeria is particu-

larly high, considering the relatively young age of affected cases,

a minimum wage of 18 000 Naira (US$120) per month and a

considerable component of out-of-pocket spending for those

affected. Health reforms designed to mitigate the individual-to-

societal burden imposed by the syndrome are required.

CARDIOMETABOLIC RISK FACTORS IN AMBULATO-

RY PATIENTS ATTENDING PRIMARY HEALTHCARE

FACILITIES IN NAIROBI, KENYA

Ogola Elijah Nyainda*, Achieng Loice, Joshi Mark, Mutai Ken

University of Nairobi, Nairobi, Kenya; elijah.ogola@uonbi.

ac.ke

Introduction:

There is a rising burden of non-communicable

diseases (NCDs) in Africa as a result of a rise in risk factors

(RFs) due to the epidemiological transition. These conditions

are largely asymptomatic, especially early on. Contact with

patients with inter-current illnesses offers an opportunity for

opportunistic screening. However primary healthcare facilities

are usually overcrowded, understaffed and underequipped,

making screening difficult, hence a lost opportunity. We inves-

tigated the prevalence of selected RFs in ambulatory patients

attending primary healthcare facilities in Nairobi.

Methods:

Twenty-four public and private facilities registered in

Nairobi were randomly selected. Patients, 35 years and above on

their index visit to the facility for the particular complaint, were

eligible for recruitment. Every fifth eligible patient was recruited

until the target of 10 per facility. Following informed consent,

a history was taken for socio-demographic data, alcohol and

tobacco use, self-reported hypertension, diabetes and HIV

status, and drug history. Blood pressure, weight and height for

BMI, and waist and hip circumference were measured. Fasting

glucose, fasting lipid profile, serum creatinine for calculation

of eGFR and serum uric acid levels were assayed. Continuous

data are presented as means and categorical data as percent-

ages. Prevalence of RFs is presented as proportions with 95%

confidence intervals (CI). Correlations were done using the

chi-square test.

Results:

We studied 213 patients. Mean age was 45

9.4 years,

and 64.3% were female. The prevalence (CI) of the RFs in

the patients were as follows: smoking: 5.6% (2.9–96); obesity:

34.9% (28.5–41.7); diabetes: 8% (4.7–12.5), hypertension: 23.5%

(18–29.5), and dyslipidaemia: 73.7% (67.3–79.5); 16.3% (11–22)

had abnormal kidney function, 14.6% were in stage 2 and 1.4%

in stage 3 renal failure. Urinary albumin was not done so it was

not possible to identify stage 1 CKD. A total of 57% of hyper-

tensives and 63% of diabetics were newly recognised. There was

a statistically significant gender difference in smoking: male

14.5%, female 0.7% (

0.0001) and obesity: male 23.55%,

female 41.2% (

0.01)

Conclusions:

There was a high prevalence of cardiometabolic

RFs, most of it unrecognised, in attendees of primary health-

care facilities for routine care. This offers an opportunity for

opportunistic screening. Training of primary healthcare work-

ers and equipping the facilities to enable screening is an impor-

tant step in the control of NCDs.

RISK-FACTOR PROFILE AND CO-MORBIDITIES IN

2 398 PATIENTS WITH NEWLY DIAGNOSED HYPER-

TENSION FROM THE ABUJA HEART STUDY

Ojji Dike*, Libhaber Elena

, Atherton John, Alfa Jacob,

Abdullahi Bolaji, Nwankwo Ada, Sliwa Karen

*Cardiology Unit, Department of Medicine, University of

Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria; dikeo-

jji@yahoo.co.uk

Hatter Institute for Cardiovascular Research in Africa,

Department of Medicine, Faculty of Health Sciences, University

of Cape Town, South Africa

Introduction:

Risk factors, co-morbidities and end-organ

damage in newly diagnosed hypertension are poorly described

in larger cohorts of urban African patients undergoing epide-

miological transition.

Methods:

We prospectively collected detailed clinical, biochemi-

cal and echocardiography data of all subjects with hypertension