Cardiovascular Journal of Africa: Vol 28 No 4 (July/August 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017 AFRICA 251
Review Article
Primary care in the prevention, treatment and control of
cardiovascular disease in sub-Saharan Africa
Dike B Ojji, Kim Lamont, Olubunmi I Ojji, Bibiana Nonye Egenti, Karen Sliwa
Abstract
Cardiovascular disease (CVD) is the frontrunner in the disease
spectrum of sub-Saharan Africa, with stroke and ischaemic
heart disease ranked seventh and 14th as leading causes of
death, respectively, on this sub-continent. Unfortunately, this
region is also grappling with many communicable, maternal,
neonatal and nutritional disorders. Limited resources and the
high cost of CVD treatment necessitate that primary preven-
tion should have a high priority for CVD control in sub-
Saharan Africa. One major challenge of such an approach
is how to equip primary care to respond promptly and effec-
tively to this burden. We present a practical approach on how
primary care in sub-Saharan Africa could effectively address
the prevention, treatment and control of CVD on the sub-
continent. For effective prevention, control and treatment of
CVD in sub-Saharan Africa, there should be strategic plans
to equip primary care clinics with well-trained allied health-
care workers who are supervised by physicians.
Keywords: cardiovascular disease, treatment, prevention, prima-
ry care
Submitted 26/4/16, accepted 14/8/16
Published online 18/7/17
Cardiovasc J Afr 2017; 28: 251–256
DOI: 10.5830/CVJA-2016-082
The global burden of disease has continued to shift away from
communicable diseases to non-communicable diseases, with
cardiovascular disease (CVD) taking the lead. The latest Global
Burden of Diseases, Injuries and Risk Factors (GBD 2010) study
report1 shows ischaemic heart disease (IHD) is the leading cause
of disability-adjusted life years (DALYs) worldwide, moving
from fourth position in 1990 and increasing in incidence by 29%.
The same report also ranks stroke as the third leading cause
of global DALYs, moving from the fifth position in 1990 and
increasing by 19%.
In sub-Saharan Africa, stroke and IHD ranked seventh and
14th, respectively, in the southern region, while they ranked 16th
and 20th, respectively, in the western region in 1990. Further
projections by the World Health Organisation (WHO)2 indicate
that by 2030, cerebrovascular and ischaemic heart disease will
overtake HIV/AIDS as leading causes of death in this sub-region.
It is further elaborated by WHO statistics that by 2030, both
cerebrovascular and ischaemic heart disease will contribute to over
20% of the total deaths and 7% of DALYs in sub-Saharan Africa.
In South Africa, cerebrovascular disease is the second commonest
cause of death after HIV/AIDS, accounting for about 40% of
adult deaths.3 Unfortunately this sub-continent is still grappling
with many communicable, maternal, neonatal and nutritional
disorders, which remain dominant causes of the burden of disease.1
The health system is therefore overstretched by the existing
burden of communicable diseases and a large burden of fast-
emerging non-communicable diseases, especially CVD. Limited
resources and the high cost of CVD treatment suggest that
primary prevention should be a priority for CVD control in
sub-Saharan Africa.4,5 One of the major challenges of such an
approach is how to equip primary care to respond promptly and
effectively to this burden. In this article, we present a practical
approach on how primary care in sub-Saharan Africa could
effectively address the prevention, treatment and control of CVD
on this sub-continent.
Primary care approach to the treatment and
prevention of diabetes and CVD
In spite of the increasing cardiovascular risk burden in
sub-Saharan Africa, many healthcare systems inmany parts of this
Department of Medicine, Faculty of Clinical Sciences,
University of Abuja, and Cardiology Unit, Department
of Medicine, University of Abuja Teaching Hospital,
Gwagwalada, Abuja, Nigeria
Dike B Ojji, MB BS, PhD,
Soweto Cardiovascular Research Unit, University of
Witwatersrand, Johannesburg, South Africa
Dike B Ojji, MB BS, PhD
Kim Lamont, MSc, MPhil, PhD
Karen Sliwa, MD, PhD
Department of Community Medicine, University of Abuja
Teaching Hospital, Gwagwalada, Abuja, Nigeria
Olubunmi I Ojji, B Ed, M Ed
Department of Community Medicine, Faculty of Health
Sciences, University of Abuja, and Department of
Community Medicine, University of Abuja Teaching
Hospital, Gwagwalada, Abuja, Nigeria
Bibiana Nonye Egenti, MB BS, MPH
Hatter Institute for Cardiovascular Research in Africa,
Department of Medicine, Faculty of Health Sciences,
University of Cape Town, South Africa
Karen Sliwa, MD, PhD