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Cardiovascular Journal of Africa • Volume 31, No 4 August 2020
S13
AFRICA
Overweight and obesity
In 2016, the prevalence of overweight [body mass index
(BMI) ≥ 25–< 30 kg/m
2
] and obesity (BMI ≥ 30 kg/m
2
) in
adults 25 years and older was 40.6 and 17.2%, respectively.
5
Compared to global data, both these indicators are much
higher than that of 38.9% for overweight and 13.1% for obesity
(Table 1).
5
Similarly to most African countries, far more
women were overweight or obese compared to men (51.9 and
25.4% vs 27.2 and 7.5%, respectively).
Diabetes
The percentage of the population defined with a fasting
glucose level ≥ 7.0 mmol/l or on medication for raised
blood glucose (age-standardised) in 2014 was 7.3% for men
and 7.5% for women. In 2019, the age-adjusted prevalence
(20–79 years) of diabetes was 4.5%, which is higher than
that of Africa (3.9%) but lower than the global level of 9.3%
(Table 1).
8
Part C: Clinical practice and guidelines
Health system capacity
In 2018, the country had an average of 4.2 physicians and
19.54 nurses, and in 2009, 27 hospital beds per 10 000 of the
population.
5
In 2009, the first medical school opened.
Before 2008 there was no specialised adult or paediatric
cardiology or cardiothoracic service in Namibia. Patients
with heart disease were treated by local paediatricians
and physicians, then referred to cardiac centres in other
African countries for interventions or surgeries. In 2008, the
WCH complex, the tertiary public hospital in the capital,
inaugurated the Cardiac Unit; the first facility in Namibia to
provide comprehensive cardiac care and surgery to children
and adults with a particular focus on RHD. Three other centres
have subsequently been set up in the private sector (two in
Windhoek and one in northern Namibia) that have supported
the state Cardiac Unit. At present, specialised paediatric and
congenital cardiac services and cardiac surgery are available
in the private and public sector. In the public sector, adult
cardiology care is provided by consultant physicians, and
specialised interventions are arranged on an
ad hoc
basis
with private cardiologists.
Although the state system initially focused on specialised
tertiary cardiovascular care, the Ministry of Health and
Social Services (MoHSS), with the support of partners,
established initiatives and programmes to address the national
cardiovascular health needs, therefore, moving from a strictly
vertical (tertiary cardiovascular centres) or horizontal (health
system strengthening through improved primary healthcare)
response to a more diagonal one (strengthening primary
healthcare and infrastructure alongside disease-specific
activities).
Currently, regarding comprehensive services in the
state sector, there is a clinical, interventional and surgical
paediatric and congenital heart disease service. A team of
super-specialists, nurses, technologists, perfusionists, medical
officers and social workers is actively involved in clinical
management and research. The adult cardiology services until
recently enjoyed similar successes but without a full-time
cardiologist, interventional procedures have been
ad hoc.
9
Reasons for slow progress include lack of, or no access
to, data for locally relevant clinical tools to assess CVD risk
or the management of RHD. Also, no system was found to
measure the quality of care provided to people who have
suffered acute cardiac events. No national CVD database
exists, however, there is a hospital-based cardiothoracic
surgical database, and cardiologists have complete datasets
regarding CVD care provided to their patients over the past
eight years (SIB, pers commun).
There is an RHD hospital-based registry, which made
it feasible for Namibia to participate in the REMEDY
study, a contemporary, multi-centre study and RHD GEN.
Network.
10
There are also locally relevant clinical guidelines
for the management of pharyngitis and rheumatic fever,
and detection and management of AF are available.
11
No
local guidelines for the management of adult CVD are
available, however the American Heart Association and the
European Society of Cardiology guidelines are followed.
12
The same applies to a national programme for adult CVD
prevention, with local physicians also following international
recommendations (SIB, pers commun). Although no national
guidelines for the treatment of tobacco dependence exist,
health education and advice to quit the habit are provided in
the Standard Treatment Guidelines.
11
Namibia has standard
treatment guidelines for diabetes mellitus and other NCD or
conditions, such as hypertension.
11
Essential medicines and interventions
Only aspirin, angiotension converting enzyme (ACE)
inhibitors and
b
-blockers could be made available at health
centres and clinics for follow-up treatment.
13
In 2019,
metformin, insulin and statins were also said to be available
in the public sector, yet these sectors have been suffering from
underfinancing, resulting in essential drugs to be unavailable
at public health pharmacies.
5
Warfarin and clopidogrel are
also not available at the public health level.
11,13
Data regarding
priority CVD risk stratification or secondary prevention of
acute rheumatic fever (ARF) and RHD at primary healthcare
facilities were not available. However, TC measurement was
available at the primary healthcare level.
5
Secondary prevention and management
The percentage of persons with hypertension receiving
medical treatment is 17%,
14
with no data available for high-
risk patients with AF receiving oral anticoagulants. Those
people with a history of CVD taking aspirin, statin and at least
one antihypertensive agent is also unknown. The percentage
of patients with RHD receiving penicillin for secondary
prophylaxis is low (33%) and the result of a combination
of non-prescription, poor adherence and disruption in the
supply chain (Namibia REMEDY data, unpublished).
Part D: Cardiovascular disease governance
Strategies focusing on assessing and reducing the burden of
NCD, which include CVD and risk factors, such as diabetes,