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

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Cardiovascular Journal of Africa • Volume 31, No 4 August 2020 S17 AFRICA
rheumatic fever and RHD through educational skills they can
pass on to their families and communities about the disease.
Furthermore, it also provides a platform for them to advocate
for their health needs. This programme is receiving continued
support from the MoHSS via the NCD desk.28 However, there
is still room for increased awareness about ARF/RHD at the
community level.
Namibia’s recorded alcohol consumption per capita
(4.4 litres) is lower than that of countries such as Uganda
(12.2 litres) and Nigeria (7.8 litres) or Tanzania and Rwanda
(7.3 and 7.0 litres, respectively) in persons ≥ 15 years
old.5 Also, policies that address the harmful use of tobacco
products, alcohol, unhealthy diets and other CVD risk factors
such as physical inactivity and obesity are in place.16
In 2011, the MoHSS published Namibia’s Standard
Treatment Guidelines, which included, among other things,
the detection and management of diabetes mellitus, rheumatic
fever and RHD.11
Threats
NCD are becoming unforeseen health issues, along with
unhealthy lifestyles competing with the high burden of
communicable diseases.15 Namibia faces enormous threats
for the funding base of the WHO country office, resulting
from a global financial crisis and recession and reduction in
donor funds.15
Namibia’s total CVD mortality rate (17.7%) is higher than
most other countries under investigation, including that of its
neighbouring country, South Africa, at 16.1%. The total RHD
mortality rate also ranks higher than most of the countries in
our study. The prevalence of tobacco use in Namibia is also of
concern when compared to the global prevalence of 36.1 and
6.8% for men and women, respectively. Similarly, adolescents’
tobacco use is much higher than the global figures shown in
Table 1. Other risk factors creating a reason for concern are
hypertension, hypercholesterolaemia, overweight and obesity,
also shown in Table 1. Hypertension prevalence of almost
46% in adults 35–64 years old, who participated in the 2013
Namibia Demographic and Health Survey, is high and reason
for concern along with other NCD risk factors.33
Some CVD, such as RHD, show a female preponderance
and affect women of childbearing age. Therefore
comprehensive reproductive health services must be made
available to these women, as pregnancy is associated
with specific maternal and foetal morbidity and mortality.
Access to information regarding their risk in pregnancy,
medication use, family planning, and a safe, reliable form
of contraception is essential. In addition to barrier methods,
progesterone implants are a safe contraception option for
women with CVD. Unfortunately, the local supply of these
has been erratic. Long-term, children under 10 years old
who receive mechanical prostheses do not fare well with
anticoagulation like their adult counterparts. Repair, if
feasible, is favoured under the circumstances.34
Weaknesses
Morbidity and mortality caused by NCD are on the
increase. The lack of funding caused some objectives not
to be met regarding NCD, such as the establishment of a
CVD budget.15
Although the prevalence of RHD is below 1%, it is still
higher than the global figure of 0.53% shown in Table 1.
The incidence of new ARF cases reflects the reality that
primary prevention is not practised broadly. Equally, the
availability of benzathine penicillin for secondary prevention
is not always guaranteed. Lately, benzathine penicillin has
been reserved mostly for children under 15 years old, while
the population beyond receives penicillin V potassium (Pen
VK). A penicillin task force was set up to investigate and
address the fragile supply chain.17
Although cardiac surgery is available locally, the waiting
lists and times are long. As patients sometimes present with
advanced disease, they may miss the window of opportunity
for curative or palliative surgery or die while waiting.34,35
Cardiac interventions and surgeries are generally available in
the private sector, with limited access to adults in the public
health sector in the light of budget and skills restrictions.9
Similar to African countries, Namibia has a shortage of
human resources and local expertise.9
Priorities
Priority areas for prevention and control are to:
• strengthen surveillance, monitoring and research to
establish disease patterns and trends
• influence policy formulation, legislation and support
planning for NCD and conditions
• promote healthy lifestyles and primary prevention.15
According to the WHO Country Cooperation Strategy 2010–
2015, transparent policy and strategy need to be defined,
and funds allocated to address the agenda through sound
partnerships with all relevant stakeholders.15 Therefore, it
is imperative to implement a well-organised and controlled
public–private partnership as a priority to secure appropriate
care for CVD patients at the public healthcare level.
The authors extend their gratitude towards Dr Simon I Beshir for his
contribution in collating the adult CVD data.
References
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