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

Cardiovascular Journal of Africa • Volume 31, No 4 August 2020

S21

AFRICA

More women were respectively overweight or obese (36.1,

13.1%) than men (21.7, 4.6%).

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 6.3% for men and

6% for women.

In 2019, the prevalence of age-adjusted

(adults 20–79 years) diabetes was 3.1%,

which is lower

than the 4% documented for 2014

or the global prevalence

of 9.3% (Table 1).

Part C: Clinical practice and guidelines

Health system capacity

The country had an average of 3.8 physicians and 11.8

nurses per 10 000 of the population in 2013 and 2018,

respectively. The number of hospital beds per 10 000 people

was five in 2008.

In 2013, Nigeria had partially developed a locally relevant

clinical tool to assess CVD risk along with guidelines for its

prevention.

Through efforts by the Nigerian Cardiac Society

task force on Rheumatic Heart Disease, locally relevant

clinical guidelines on the management of pharyngitis, acute

rheumatic fever (ARF) and RHD have also been partially

implemented. However, no guidelines for the detection and

management of AF or the treatment of tobacco dependence

are available.

Nigeria participated in the REMEDY study, a prospective,

international,multi-centre, hospital-based registry that provides

all-inclusive up-to-date data on patients with RHD and will

assist in developing preventative and management strategies.

In a prospective registry, the RE-LY AF (Randomized

Evaluation of Long-Term Anticoagulation Therapy), Nigeria

provided significant data as part of theAfrican leg that enrolled

1 137 patients presenting to emergency units with AF.

RHD

was present in 21.5% of participants from the nine African

countries.

The country is also part of the INVICTUS trial

(INVestIgation of rheumatiC AF Treatment Using vitamin

K antagonists, rivaroxaban or aspirin Studies), which is a

clinical trial investigating the safety and efficacy novel oral

anticoagulants.

19,20

A system to measure the quality of care

provided to people who have suffered acute cardiac events

has not been implemented. However, diabetes guidelines were

introduced by the Diabetes Association of Nigeria in 2013.

Essential medicines and interventions

Although the Essential Medicine List includes at least seven

of the eight essential CVD/NCD medicines, not all of these

are available at the primary healthcare level.

In 2019,

only aspirin was available at primary care facilities in the

public health sector.

No data were available for CVD risk

stratification in primary healthcare facilities, total cholesterol

measurement or secondary prevention of ARF and RHD in

public sector health facilities.

Secondary prevention and management

In 2011, 23.07% of high-risk patients with AF were on oral

anticoagulant treatment.

Through a global initiative of the

International Society of Hypertension in 2017, 12.9% of

people were receiving treatment for high blood pressure.

However, no data are available on people with a history of

CVD taking aspirin, statin and at least one antihypertensive

agent.

Part D: Cardiovascular disease governance

In2019,Nigeria launched itsfirst nationalmulti-sectoral action

plan (NMSAP) for the prevention and control of NCD, 2019–

2025, with targets and a roadmap for its implementation.

As an immediate gain, a specialised package for essential

NCD intervention as well as national hypertension treatment

protocol was developed for implementation at the primary

healthcare level.

The NMSAP will address CVD and the

risk factors through Nigeria’s Federal Ministry of Health

(FMoH) in partnership with other key stakeholders, such as

the National Primary Healthcare Development Agency.

The

budget allocation for such implementation was previously

reported to be less than the 15% minimum recommended by

the WHO, possibly because of the recession, among other

factors.

A focal unit has been identified at the Federal and

State Ministry of Health that is responsible for implementing

and controlling NCD and the associated risk factors.

16,28

According to the National Policy and Strategic Plan of

2013, RHD prevention and control is being addressed as a

priority.

Furthermore, a national surveillance and monitoring

system has been implemented that includes CVD and their risk

factors, in conjunction with relevant agencies/organisations.

29,30

Various organisations advocated for the enactment of the

Tobacco Control Act, which was passed in 2015.

28,31

Collaborative CVD intervention projects have been

implemented between the Ministry of Health and non-

health ministries, such as the Federal and States Ministries

of Education and Information,

and other stakeholders.

The percentage of total annual government expenditure on

cardiovascular healthcare is unknown. In 2003, Hutubessy

et al.

reported data for Nigeria, whereby the benefits of

CVD prevention and control for population health and the

economy had been modelled.

Assessment of policy response

Legislation was recently signed as part of the National Health

Bill mandating health financing and essential medicines

at affordable prices for CVD. The bill was named, Senate

Bill 278, with the title, National Health Insurance Act, 2003

(Repeal and Re-enactment) Bill 2019.

The following legislation and policies regarding tobacco

control

35,36

are in use:

• banning of smoking in all public places (indoor and

outdoor) including public transport

• clear and visible text warnings on at least half of the

principal display areas of tobacco packs. Implementation

of text and graphic health warnings were reported in 2014

• banning all forms of tobacco advertising, promotion and

sponsorship

• gradual raising of excise tax on tobacco products

• measures to protect tobacco control policies from tobacco

industry interference.