6 / 46
AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S6
Comprehensive needs assessment for arterial hypertension management cascade at an urban hospital in
a low-income country
Neusa Bay*, Edna Juga
#
, Ana Olga Mocumbi
#
, Carlos Macuacua
†
, José João† and Maria Helena da Costa
‡
*MIHER Mozambique Institute for Health Education and Research, Maputo, Mozambique.
#
Instituto Nacional de Saúde, Maputo, Mozambique.
†
Universidade Eduardo Mondlane, Maputo, Mozambique.
‡
Hospital Geral de Mavalane, Maputo, Mozambique
Introduction:
Hypertension is the leading preventable risk factor for premature death and disability worldwide, but global hypertension disparities are large
and have been increasing. Despite Mozambique’s increasing trend in prevalence, the levels of awareness, treatment and control are low. Our study aimed to
describe the hypertension care cascade and identify gaps in availability and affordability of services for its control.
Methods:
From September 2018 - December 2018 we conducted a needs assessment of hypertension care provision at a first-referral urban hospital in
Mozambique’s capital. Questionnaires, surveys and guides for direct observation of services were developed based on merging and adapting the Package
of Essential NCD interventions for primary health care in low-resource settings (PEN), the Service Availability and Readiness Assessment (SARA) and the lean
healthcare (LHC) approach.
Results:
We found critical gaps in human resources, clinical equipment, diagnostics and medicine availability. Less than 2% of adults were diagnosed as
having hypertension (2 464/159 303) of which 21.4% (527.3) were severe and complicated. No flow according to hypertension severity, nor an integrated
chronic case management system existed. There were long patient waiting times for first evaluation, blood collection, chest x-ray and medicine dispensing,
requiring at least 5 hospital visits. Availability of medicines recommended by the national medicines list was 12.82% on average. Patients spent up to 24.4%
of their monthly wage to purchase one single medicine, equivalent to approximately 8 days of work. Lack of surveillance systems and irregular supply chains
were also major barriers to hypertension control.
Conclusion:
Health facility readiness to address arterial hypertension in this highly prevalent urban setting in Mozambique was low, with marked
unavailability of trained health professionals, clinical equipment, diagnostics and medicines. Low medicines affordability, lack of guidelines and absence of
efficient supply chain were major barriers to care. Health facility quality improvement measures are recommended.
Heart catheterisation in adults in a sub-Saharan tertiary centre: An 8-year experience
Tantchou Tchoumi Cabral, Jean Claude Ambassa and Charles Mvondo
Cardiac Centre Shisong, Kumbo, Cameroon
Introduction:
The goal of the investigation was to analyse the results of heart catheterisation in the Shisong Cardiac Centre from December 2010 -
December 2017.
Methods:
This retrospective study was done at the Shisong Cardiac Centre in adult patients who had undergone a procedure in the catheterisation
laboratory from December 2010 - December 2017.
Results:
Three hundred and sixty-five adult patients underwent cardiac catheterisation during the study period, 126 female and 239 male. The mean
age at presentation was 52.6 ± 12.9 years. Patients hailed from neighboring countries: Nigeria n=5 (1.3%), Tchad n=3 (0.8%), Equatorial Guinea n=4 (1%)
and Democratic Republic of Congo n=2 (0.5%). Patients also came from all 10 regions in Cameroon: Littoral n=122 (33.2%), Centre n=127 (34.8%), North-
West n=47 (12.9%), South-West n=17 (4.5%) , West n=26 (7.1%), North n=7 (1.8%), Adamaoua n=8 (2.1%), Far North n= 5 (1.3%), South n=2 (0.5%) and East
n=4 (1%). Diagnostic coronarography (in cases where coronary artery disease was suspected) and presurgical coronarography were the main procedures
performed in 171 (46.8%) and 146 patients (40%), respectively. Diagnostic coronarography was positive in 31 cases (8.4%). In patients with ischaemic heart
disease, percutaneous intervention with dilatation of the coronary arteries and implantation of stents was done in 19 cases (5.2%). The remaining 12 cases
(3.2%) were mainly lesions that could be addressed by coronary artery grafting surgery alone. These procedures were all performed successfully. In grown-
up congenital heart disease patients, diagnostic catheterisation was done in 48 cases, interventional catheterisation namely pulmonary artery valvuloplasty,
patent ductus arteriosus closure, atrial septal defect closure and decoarctation of the aorta were done in n=11 (3.4%), n=9 (2.4%), n=12 (3.2%), n=6 (1.6%)
cases, respectively.
Conclusion:
Coronary heart disease was confirmed by angiography in 8.4% cases and amongst adult congenital heart disease patients, atrial septal defect
was the pathology most often managed. Heart catheterisation at the Shisong Cardiac Centre is performed with good results.
Symptomatic children with post-rheumatic valvulopathies in natural history: A 5-year follow-up
Tantchou Tchoumi Cabral and Jean Claude Ambassa
Cardiac Centre Shisong, Kumbo, Cameroon
Introduction:
The aim of the study was to investigate the pattern of valvular lesions, the mortality and the challenges in a 5-year follow-up of symptomatic
children with post rheumatic valvulopathies in natural history in St. Elizabeth Catholic General Hospital cardiac centre.
Methods:
This retrospective analysis included 95 patients, aged between 5 and 16 years, who could not have surgery done in the cardiac centre from July
2008 - July 2013. Data from patients’records, 2-dimensional echocardiographic studies and electrocardiograms were reviewed. Patients and their families
were contacted every 6 months. The duration of the follow-up was 60 months.
Results:
The 95 symptomatic patients were aged between 5 and 16 years old with a mean age of 12.4 ± 4.5 years. Mitral regurgitation was the most
common echocardiographic diagnosis present in 51.7% patients; 13.3% patients had mixed mitral valve disease and 35% had pure mitral stenosis. Pulmonary
hypertension was the most common echocardiographic complication of the disease in 87% of cases. Clinically, complications of the disease included:
congestive heart failure, fatigue, growth retardation and sudden death. On presentation, 78% of cases were admitted. Mortality in 2 years was 55% and in 5
years 75%.
Conclusion:
Post-rheumatic mitral valve regurgitation is the pathology most commonly encountered. Pulmonary hypertension is the most common
echocardiographic complication of the disease. In our setting, 5-year mortality is very high.