Cardiovascular Journal of Africa: Vol 31 No 4 Supplement (July 2020)

11 / 57

Cardiovascular Journal of Africa • Volume 31, No 4 August 2020 S9 AFRICA
higher prevalence of RHD, at 3.04%.6 Total RHD mortality
(0.16%), was somewhat higher than that of Tanzania (0.14%)
but lower than South Africa’s 0.22%.5
Weaknesses
Six of the eight essential medicines for CVD were only
available some of the time and only in some of the public
health centres (AD, pers commun). Only metformin is
generally available at primary care facilities, while insulin is
not.43 In a study by Beran et al.44 published in 2005, insulin
was not reportedly available at any of the six health centres.
Primary healthcare facilities generally do not provide
TC measurements, and CVD risk stratification at this level
is also not prioritised. Very few people with hypertension
and CVD are receiving treatment.38 Only in 2017 after a
long process did Mozambique ratify the FCTC. However,
at the time, some tobacco control policies had already been
implemented,24 while national guidelines to treat tobacco
dependence are lacking. Sustainable funding for CVD
from taxation of tobacco or other ‘sin’ products also does
not exist.
No locally relevant CVD/NCD guidelines are available.
Mozambique, along with most sub-Saharan African
countries except South Africa, has not yet introduced a
policy regarding the taxation of unhealthy foods or sugar-
sweetened beverages to combat obesity and other related
NCD.45 Legislation banning the marketing of unhealthy
foods to minors and mandating clear and visible warnings
on foods that are high in calories, sugar or saturated fats
are also lacking. Policy interventions to reduce CVD risk
through promoting a healthy diet has not yet been introduced.
Stakeholder involvement shows little evidence, although
there have been indications of civil society involvement in
preventing CVD.25,34,35,42
Weaknesses in the surveillance systems do not allow the
recognition of the burden of neglected CVD in Mozambique.
However, some are highly relevant (e.g. RHD prevalence
and cardiomyopathies) and have been included in the
new strategic plan of the National Public Health Institute,
prioritising research, education and surveillance of these
conditions.46,47
Priorities
Mozambique’s National Strategic Plan for the prevention
and control of NCD was introduced in 2008 to create a
positive environment to minimise or eliminate the exposure
to risk factors and guarantee access to care.20,23 In the next
Plano Estratégico do Sector da Saúde (PESS) that outlines
the 2014–2019 strategies for Mozambique, one of its top
priorities is to reduce the NCD burden.42 As part of the NCD
programme, a few strategic goals were highlighted. These
included health-promoting activities such as the prevention
and treatment of NCD by training healthcare personnel and
increasing services; developing plans and guidelines for
NCD; strengthening and expanding surveillance systems,
along with advocacy for increased community and civil
society involvement in preventing and controlling NCD and
related risk factors.42
Another priority is diabetes care in Mozambique that is
changing, compelling them to assess these changes to stem
the rising tide of this risk factor.19
The tobacco control plan progress needs to be evaluated,
as the problem remains despite the increase in excise tax. In a
country brief, the World Bank Group Global Tobacco Control
Program recommended fiscal and public health benefits for
Mozambique. These included unified cigarette-specific excise
rates with annual increases to reduce consumption; increased
cigarette taxes and prices to reduce cigarette smuggling; and
improved tobacco control monitoring.26
This publication was reviewed by the PASCAR governing council and
written in association with the Heart Association of Mozambique.
References
1. Mohamed AA, Fourie JM, Scholtz W, et al. Sudan Country Report: PASCAR
and WHF Cardiovascular Diseases Scorecard project. Cardiovasc J Afr 2019;
30: 305–310.
2. Dzudie A, Fourie JM, Scholtz W, et al. Cameroon Country Report: PASCAR
and WHF Cardiovascular Diseases Scorecard project. Cardiovasc J Afr 2020;
31(2): 103–110.
3. World Bank, [Online] 2018.
4. World Health Organization. CVD World Monitor. [Online] 2012. http://
5. Institute for Health Metrics and Evaluation (IHME). GHDx. Global Health
Data Exchange. [Online] 2017.
6. Marijon E, Ou P, Celermajer DS, et al. Prevalence of rheumatic heart disease
detected by echocardiographic screening. N Engl J Med 2007; 357: 470–476.
7. Damasceno A, Cubula B, Lunet N. WHO STEPS – Moçambique 2014/15
RELATÓRIO FINAL. Maputo: unpublished report 2017.
8. World Health Organization. The Global Youth Tobacco Survey. Fact Sheet
Mozambique. [Online] 2013.
php/catalog/154.
9. Global Report on Mortality Attributable to Tobacco. Geneva, Switzerland:
WHO, 2012.
10. The Global Health Observatory (GHO). WHO. [Online] 2020. https://www.
who.int/data/gho/.
11. Jessen N, Damasceno A, Silva-Matos C, et al. Hypertension in Mozambique:
trends between 2005 and 2015. J Hypertens 2018; 36: 779–784.
12. Guthold R, Stevens GA Riley LM, et al. Global trends in insufficient physical
activity among adolescents: a pooled analysis of 298 population-based surveys
with 1·6 million participants. Lancet Child Adolesc Health 2020; 4(1): 23–35.
13. Padrão P, Damasceno A, Silva-Matos C, et al. Physical activity patterns in
Mozambique: Urban/rural differences during epidemiological transition. Prev
Med 2012; 55(5): 444–449.
14. Fontes F, DamascenoA, Jessen N, et al.Prevalence of overweight and obesity in
Mozambique in 2005 and 2015. Public Health Nutr 2019; 22(17): 3118–3126.
15. International Diabetes Federation. IDF Diabetes Atlas, 9th edn. [Online]
2019.
16. World Health Organization. Mozambique STEPS Survey 2005.
Noncommunicable diseases and their risk factors. [Online] 2005. https://
www.who.int/ncds/surveillance/steps/mozambique/en/.
17. Karthikeyan G, Zühlke L, Engel M, et al. Rationale and design of a Global
Rheumatic Heart Disease Registry: The REMEDY study. Am Heart J 2012;
163(4): 535–540.
18. Busko M. Valvular atrial fibrillation with HF. Common, often untreated in
Young Africans. Medscape. [Online] 07 June 2016. [Cited: 8 May 2019.]
19. Silva-Matos C, Gomes A, Azevedo A, et al. Diabetes in Mozambique:
Prevalence, management and healthcare challenges. Diabetes Metab 2011;
37: 237–244.
20. Silva-Matos C, Beran D. Non-communicable diseases in Mozambique: risk
factors, burden, response and outcomes to date. Glob Health 2012; 8: 37.