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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020
AFRICA
267
Cardiovascular Topics
PASCAR and WHF Cardiovascular Diseases Scorecard
project
Habib Gamra, Jihene Maatoug, Jean M Fourie, Wihan Scholtz, Oana Scarlatescu, George Nel, Hassen
Ghannem
Abstract
Data collected by the Pan-African Society of Cardiology for
the World Heart Federation’s scorecard project regarding the
current state of cardiovascular disease prevention, control
and management along with related non-communicable
diseases in Tunisia are presented. Furthermore, the strengths,
threats, weaknesses and priorities identified from these data
are highlighted in concurrence with related sections in the
incorporated infographic. Information was collected using
open-source data sets available online and relevant govern-
ment publications.
Cardiovasc J Afr
2020;
31
: 267–273
DOI: 10.5830/CVJA-2020-043
Onbehalf of theWorldHeartFederation (WHF), thePan-African
Society of Cardiology (PASCAR) co-ordinated data collection
and reporting for the country-level Cardiovascular Diseases
Scorecard to be used in Africa.
1-3
The objectives of the scorecard
have previously been published along with data from seven
African countries.
3
The Tunisian Heart Foundation, a member
of PASCAR and the WHF, along with epidemiologists from the
University of Sousse, assisted in collating and verifying the data.
Based on the data collected, we summarise the strengths,
threats, weaknesses and priorities identified, which need to
be considered in conjunction with the associated sections
provided in the infographic published with this report. Data sets
used included open-source data from the World Bank, World
Health Organization (WHO), Institute for Health Metrics and
Evaluation and the International Diabetes Federation (IDF),
along with other relevant and government publications.
Part A: Demographics
According to the World Bank (2018), Tunisia is a lower-middle-
income country with 31% of its people living in rural areas.
4
As indicated by the National Institute of Statistics, 2.9% of
the population was living in extreme poverty in 2015.
5
Life
expectancy at birth in 2018 was 74 and 79 years for men and
women, respectively.
4
The general government health expenditure
was 4.1% of the gross domestic product (GDP) in 2017, while the
country’s GDP per capita was US$3 317.5 in 2019.
4
Part B: National cardiovascular disease
epidemic
The national burden of cardiovascular diseases
(CVD) and risk factors for non-communicable
diseases (NCD)
Tunisia’s premature deaths, attributable to CVD (30–70 years
old), was 11% in 2012,
6
while 44% of the estimated NCD deaths
(86%) accounted for CVD in 2016.
7
In 2017, the age-standardised
total CVD death rate was very high at 51.5%, compared to 31.8%
for the Global Burden of Disease (GBD) data.
8
The percentage
of disability-adjusted life years (DALYs) resulting from CVD
for men was 23.8% and for women 19.4%, which is also higher
than the GBD data of 14.66% for both genders. The prevalence
of atrial fibrillation (AF) and atrial flutter was 0.3%, while that
of rheumatic heart disease (RHD) was 0.01% compared to the
GBD data of 0.53%. The total RHD mortality rate was 0.15% of
all deaths, which is lower than the GBD data of 0.51% (Table 1).
8
Tobacco and alcohol
Data on the prevalence of tobacco use for adult men and women
(≥ 15 years old) in 2018 were 49.3 and 2.9%, respectively. In 2008,
the prevalence of smoking in adolescents (13–15 years old) was
20.1 and 3.8% for boys and girls, respectively.
9
The proportion of
premature CVD mortality attributable to tobacco is 5%, which
is much lower than the global 10%,
10
while the estimated annual
direct cost of tobacco use is unknown. The three-year (2016–18)
average recorded alcohol consumption per capita (≥ 15 years)
was 1.6 litres (Table 1).
9
The Tunisian Heart Foundation, Tunisia
Habib Gamra
Department of Epidemiology, Faculty of Medicine, Farhat
Hached Hospital, University of Sousse, Sousse, Tunisia
Jihene Maatoug
Hassen Ghannem
Pan-African Society of Cardiology, Cape Town, South
Africa
Jean M Fourie
Wihan Scholtz,
wihan@medsoc.co.zaGeorge Nel
World Heart Federation, Geneva, Switzerland
Oana Scarlatescu
Tunisia Co nt y Report