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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018
AFRICA
337
In a prior issue of the Journal, simultaneously published
elsewhere, Zille and colleagues documented the lack of cardiac
surgical facilities in Africa.
1
It is with mixed feelings that I
draw your attention to the Pan-African Society of Cardiology
(PASCAR) position paper on reproductive healthcare for women
with rheumatic heart disease.
2
The contribution from Mocumbi
and collaborators paints a dismal picture, as does the Cape Town
Declaration, of the lack of availability of cardiovascular services
(CVS) to much of the population of Africa. Both surgical
services and reproductive healthcare for women with rheumatic
heart disease (RHD) need to be corrected as rapidly as possible
to ensure appropriate treatment for patients suffering from RHD.
Unfortunately, in my view, in Africa, CVS services are seen
as sophisticated and expensive, requiring major investments
in buildings and diagnostic and therapeutic equipment, often
beyond the budgetary constraints of many states. And it will
take many years to develop and to recruit the staff needed to run
them. Mocumbi and co-authors state
‘
Health professionals in
Africa should adopt a pro-active attitude to holistically address
the reproductive and cardiovascular health needs of women
with RHD. Owing to the high risk associated with pregnancy,
these women should be prioritised for appropriate contraceptive
advice.’ To me this is one of the most useful recommendations
to be proposed in this document and I wholeheartedly support
it. Given the sad state of cardiac surgery in most of Africa, a
significant number of young women with significant RHD who
become pregnant will not survive to see their children reach
adulthood.
The authors of the document point out that there is no
consensus on the best means of contraception for young
women with RHD, but perhaps PASCAR could be encouraged
to commission a task team to address the issue and develop
recommendations applicable and acceptable to Africa and
Africans. A lack of consensus does not mean that we cannot
decide on the best possible approach. This is, in my view, an
important role for PASCAR and should be undertaken in
co-operationwithwomen and civil society women’s organisations.
Most contraceptive measures can be implemented at low cost
by healthcare workers at primary level, as can secondary
prophylaxis against recurrent RHD. Development of systems to
implement such programmes may prove to be a better investment
for the continent than pursuing the installation of expensive
infrastructure.
It is unusual, but not unknown, for a journal devoted
to cardiovascular disease to publish an article, the authors
of which are from a faculty of theology. The interaction
between cardiovascular illnesses, religion, social support and
family structures are well documented and it is a pleasure to
be able to publish a report by le Roux and colleagues
3
that
explores this further. In an investigation of black and white
South African school teachers, they explored hypertension,
depression and methods of coping with depression in the
different ethnic groups, and found significant differences.
Interpretation of such differences will always be difficult and
subject to criticisms regarding inter-ethnic differences between
researchers and research participants, but the results do seem to
indicate important differences in the ways that people cope with
emotional disturbance.
I had thought that the arguments for transradial access for
coronary angiography and interventional procedures (TRI)
against a transfemoral approach had been settled with several
analyses demonstrating reduced bleeding complications from
the TRI approach. Lee and colleagues
4
believed the matter was
not settled with regard to intervention after non-ST-segment
elevation myocardial infarction. They conducted a registry in 20
Korean centres and confirmed that the major benefit of the TRI
approach was a reduction in bleeding complications.
Ngango and Omole document the risk factors for
cardiovascular disease in hypertensives in a primary healthcare
setting in South Africa.
5
The encouraging information is that
60% of patients had blood pressure controlled to target. Other
than that there were few surprises revealed in the data. This is not
unexpected, given the universality of the human condition, which
transcends ethnic differences. Increasingly, African authors are
submitting articles for publication that describe regional or
ethnic risk factors for cardiovascular disease or cardiovascular
disease characteristics. In future, these articles will be subjected
to increased editorial and reviewer scrutiny to ensure that the
information supplied is new in terms of global CVS information,
supplies genetic or other arguments to explain why the African
information is important, or provides an alternative solution
suitable for African conditions.
References
1.
Zilla P, Bolman RM, Yacoub MH, Beyersdorf F, Sliwa K, Zühlke L,
et al
. The Cape Town Declaration on Access to Cardiac Surgery in the
Developing World.
Cardiovasc J Afr
2018;
29
(4): 256–259.
2.
Mocumbi AO, Jamal KKF, Mbakwem A, Shung-King M, Sliwa K.
The Pan-African Society of Cardiology position paper on reproductive
healthcare for women with rheumatic heart disease.
Cardiovasc J Afr
2018;
29
(6): 396–404.
3.
Le Roux S, Lotter G, Steyn HS,Malan L. Cultural coping as a risk for
depression and hypertension: the SABPA prospective study.
Cardiovasc
J Afr
2018;
29
(6): 367–374.
4.
Lee M-H, Bang DW, Park BW, Cho B-R, Rha S-W, Jeong MH,
et al
.
Transradial versus transfemoral intervention in non-ST-segment eleva-
tion acute coronary syndrome patients undergoing percutaneous coro-
nary intervention: the Korean transradial intervention registry of 1 285
patients.
Cardiovasc J Afr
2018;
29
(6): 375–382.
5.
Ngango J, Omole OB. Prevalence and sociodemographic correlates of
cardiovascular risk factors among patients with hypertension in South
African primary care.
Cardiovasc J Afr
2018;
29
(6): 344–352.
Pat Commerford
Editor-in-Chief
From the Editor’s Desk