Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

13 / 80

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017 AFRICA 147
Prevalence of selected cardiometabolic risk factors
among adults in urban and semi-urban hospitals in four
sub-Saharan African countries
Samuel Kingue, Solofonirina Rakotoarimanana, Nirina Rabearivony, Francois Lepira Bompera
Abstract
Aim: Cardiovascular diseases (CVDs) are a global challenge
but the burden in sub-Saharan African (SSA) countries is less
well documented than elsewhere. We aimed to describe the
key cardiometabolic risk factors in four SSA countries.
Methods: A cross-sectional, multi-national, hospital-based
study was carried out among adults (> 35 years) across
four SSA countries from 12 December 2011 to 7 February
2013. Risk factors were defined using the World Health
Organisation and International Diabetes Federation guide-
lines.
Results: Of the 844 adults (57.4% female, mean age 52.6
years), 76.6% were urban residents. The predominant CVD
risk factors were hypertension (74.1%), obesity (36.2%) and
excessive alcohol consumption (25.6%). Diabetes (17.7 vs
10.0%), obesity (42.8 vs 16.8%) and hypercholesterolaemia
(25.8 vs 18.0%) were more prevalent among the hypertensive
subjects (all p < 0.007) than the normotensives. The metabolic
syndrome (39.4%) was more common in women and hyper-
tensive subjects.
Conclusions: Hospital patients in SSA countries present with
excessive rates of cardiometabolic risk factors. Focus on their
prevention and control is warranted.
Keywords: cardiovascular risk factors, metabolic syndrome, sub-
Saharan Africa
Submitted 19/12/15, accepted 10/7/16
Published online 22/8/16
Cardiovasc J Afr 2017; 28: 147–153
DOI: 10.5830/CVJA-2016-072
Non-communicable diseases (NCDs) are rapidly increasing in
incidence in sub-Saharan Africa (SSA). Cardiovascular disease
(CVD) is the leading contributor to the global burden of
NCDs.1 Hypertension, which is the main driver of CVD, has
been estimated to affect about 972 million adults worldwide, a
figure that is projected to increase by 60% by the year 2025.2,3
This high prevalence of hypertension is coupled with poor
detection, treatment and control rates.4
Diabetes mellitus is also a leading cause of morbidity and
mortality from NCDs and a major precursor of CVD.5 The
population of people with diabetes in SSA is growing more
rapidly than anywhere else, and is expected to nearly double
within the next two decades. 6 The co-occurrence of diabetes and
hypertension in the same individual compounds the harmful
effects of each condition.
A recent cross-sectional study conducted in semi-urban
Cameroon has indicated the co-occurrence of diabetes and
hypertension, affecting up to 5% of adults.7 Other common
drivers of NCDs and the CVD burden include physical inactivity,
smoking, unhealthy diet, dyslipidaemia, excess weight and
alcohol abuse.8,9
Monitoring the risk profile of the population is an extremely
important component of the strategy to prevent and control
NCDs in general and CVD in particular. This pivotal role was
recently highlighted in the World Health Organisation (WHO)
global action plan of 2013–2020 for the prevention of NCDs. 10
Given the silent nature of hypertension and other risk factors,
and the lack of awareness of them in low- and middle-income
countries (LMICs), opportunistic screening and awareness have
been highlighted by the World Heart Federation as the key first
steps to improving management and prevention.11
Studies addressing the risk profile of individuals who have
contact with hospitals in Africa are lacking, and most of the
existing studies are single-country studies, therefore offering less
opportunity to examine between-country variabilities. This report
is on a multi-country, multi-centre, health facilities-based study
to assess the distribution of major cardiometabolic risk factors in
adults in urban settings across different countries in SSA.
Methods
This was a multi-national, multi-centre, cross-sectional study
conducted from 12 December 2011 to 7 February 2013. The
following SSA countries participated in the study: Cameroon
(13 centres), Nigeria (five centres), Democratic Republic of
Congo (DRC) (11 centres) and Madagascar (24 centres). The
study centres were purposefully selected from the health districts
of the capital cities (urban and semi-urban) in the participating
countries. Participating centres included both public and private
healthcare facilities. General practitioners working in the selected
centres were trained to consecutively recruit all individuals aged
over 35 years to their facilities, regardless of the reason for the
visit to hospital, if they were resident in the particular city for at
least three months.
Department ofCardiology, Faculty of Medicine of Yaounde,
General Hospital of Yaounde, Yaounde, Cameroon
Samuel Kingue, MD,
Department ofCardiology, Joseph Raseta Defelatalala
University Hospital, Antananariv, Madagascar
Solofonirina Rakotoarimanana, MD,
Nirina Rabearivony, MD
Division of Nephrology, Department of Internal Medicine,
University Clinic, Democratic Republic of Congo
Francois Lepira Bompera, MD