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

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AFRICA
Cardiovascular Journal of Africa • Volume 31, No 4 August 2020 S24
Sustainable funding for CVD from ‘sin’ tax is not
available. The percentage of excise tax of the final consumer
price of tobacco products is 20.63%,35 and 60% for alcohol
products. 37 Although access to healthcare professionals and
facilities, 38 and screening of individuals at high risk of CVD
are available, there has not been any active follow up to
ensure these services are implemented. 39
Taxes on unhealthy foods or sugar-sweetened beverages
have been instituted,5 and a draft document was tabled
banning the marketing of unhealthy foods to minors in 2018.40
Legislation mandating clear and visible warnings on foods
that are high in calories, sugar or saturated fats is functional.41
Policy interventions that promote a diet to reduce CVD risk
and facilitate PA have also been implemented.36
Stakeholder action
In 2018, advocacy for CVD policies and programmes by non-
government organisations (NGO) and those for CVD/NCD
prevention and management through the active involvement
of patients’ organisations had been implemented. 42 Advocacy
champions and patient engagement were reported for
RHD in 2014.43 Various civil societies were involved in
the development and implementation of a national tobacco
control plan 35 and a CVD prevention and control plan.44
Civil society was also involved in the national multi-sectoral
co-ordination mechanism for NCD/CVD.36
Nigeria is one of the few African countries that reported
specific activities by cardiology professional associations,
which aim at a 25% reduction in the premature CVD
mortality rate by 2025.45 Screening for medical conditions,
including hypertension, was reported in a study in 2018.46
As part of the data gathered for Nigeria, the following
strengths, weaknesses, threats and priorities are summarised.
Strengths
The National Policy and NMSAP for the Prevention and
Control of Non-Communicable Diseases were developed
to ensure that policies are implemented that will prompt
and guarantee a healthy lifestyle and quality health for all
Nigerians.16,25 As a member state of the WHO, Nigeria is
a signatory to the resolution and conventions that were
adopted at the World Health Assembly and other related
NCD meetings.16 The National Health Insurance Scheme
(NHIS) was established to include all NCD and ensure that
everybody has access to sound healthcare services.38
As part of the RE-LY AF, REMEDY and INVICTUS
studies, Nigeria has clinical registers of people with a history
of AF, rheumatic fever and RHD available.17-19 The Nigerian
Cardiac Society has completed registries on acute and
chronic heart failure (HF), acute coronary syndromes and
peripartum cardiomyopathy.47,48 The country contributed over
40% of data towards the THESUS-HF (sub-Saharan African
Survey of Heart Failure, a multi-centre African registry of
acute HF) survey.49 Nigeria, as one of five African countries,
participated in the International Congestive Heart Failure
study (INTER-CHF) and the ongoing global HF registry.50
In another multi-centre, randomised, controlled trial of an
influenza vaccine to reduce adverse vascular events (IVVE)
in patients with heart failure, Nigeria is actively participating
and had enrolled 1 011 patients by January 2019. 51 A national
surveillance system that includes CVD and their risk factors
also exists.30 Evidence of stakeholder involvement and
advocacy in the prevention and management of NCD, CVD
and related risk factors is very much present in Nigeria.42-44
According to the WHO Framework Convention on
Tobacco Control (FCTC) report of 2018, there was no
national tobacco control plan. A national tobacco control
committee, with members from ministries, departments and
agencies, was inaugurated on 12 July 2016 as part of a tobacco
control co-ordination mechanism but this is yet to be extended
to the state level.35 The implementation for such a plan was
recommended in 2012,32 with civil society involved in the
development and implementation of a national tobacco control
plan.35 Legislation, however, was reported for the banning of
smoking in indoor workplaces and all public places, as well as
all forms of tobacco advertising, promotion and sponsorship.35
Legislation regarding clear and visible warnings on at least half
of the principal display areas of tobacco packs and measures
to protect tobacco control policies from tobacco industry
interference was also mandated. 35 Furthermore, Nigeria
rendered excise tax on the final consumer price of tobacco
and alcohol products.37 Legislation mandating health financing
for CVD, along with providing essential CVD medicines at
affordable prices, has recently been implemented as part of the
National Health bill signed in 2019.34
Threats
Along with globalisation, urbanisation and industrialisation,
new lifestyles and risky behaviours have inflicted chronic
diseases.16 In Nigeria, CVD comprise the highest burden
of NCD, with hypertension adding to cardiac failure and
stroke. Therefore, one in four healthy Nigerians were at
risk to develop coronary heart disease in 2010.39 Alikor and
Emem-Chioma52 noted that a rising trend in the burden of
CVD increased in the presence of clustering of risk factors,
including socio-economic status in a rural population.
Along with diabetes, overweight and obesity, and a
sedentary lifestyle, the resultant NCD are possibly the cause
of the higher premature CVDmortality rate compared to most
of the African countries in our project.38 Nigeria’s percentage
of premature CVD mortality is similar to that of Namibia and
its neighbouring country, Cameroon, at 12%, which is higher
than most of the other African countries investigated.
Raised blood pressure among women (25%) is higher than
the global figure of 20.1%, while that for men (22.7%) is
just below the global 24.1%. Overweight and obesity tend
to be a problem, as in most African countries, however, the
prevalence in Nigeria is slightly lower than the global data of
38.9 and 13.1%, respectively (Table 1).
In 2014, Nigeria had a prevalence of 4% diabetes,6
while in 2015, this was 2.8%, translating to 1:53 Nigerians
suffering from diabetes.53 However, in 2019 the IDF reported
a 3.1% prevalence of diabetes.15 By 2017, Nigeria had not
yet conducted a WHO STEP survey, although the minister of
health had envisaged planning one.53 There is a rising trend in
the cardiovascular disease burden in Nigeria, resulting from
an increasing rural–urban migration and socio-economic