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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

www.cvja.co.za

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

report

1

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,

dikeojji@yahoo.co.uk

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