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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020
268
AFRICA
Raised blood pressure and cholesterol
In 2015, about 24% of men and 22.5% of women had raised blood
pressure (BP) (systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg) levels,
which is more or less similar to the GBD data of 24.1 and 20.1%
for men and women, respectively.
9
In 2017, the percentage of
DALYs lost because of hypertension was 12.74%, while mortality
rate caused by hypertensive heart disease was 3.55 versus 1.65%
for global data (Table 1).
8
The percentage of individuals with
raised total cholesterol levels (
≥
5.0 mmol/l) was 40.7% compared
to Global Health Observatory (GHO) data (38.9%).
9
Physical activity
Data for 11–17-year-old adolescents indicated that 81.4% were
insufficiently active [< 60 minutes of moderate- to vigorous-
intensity physical activity (PA) daily]. The age-standardised
estimate for adults who were insufficiently active (< 150 minutes
of moderate-intensity PA per week or < 75 minutes of vigorous-
intensity PA per week) was 30.4%, which is higher than GHO
data at 27.5% (Table 1).
9
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 almost 62 and 27%, respectively.
9
Compared
to global data, both these indicators are much higher than the
38.9% for overweight and 13.1% for obesity.
9
More women than
men were overweight (65.8 vs 57.1%) and obese (34.3 vs 19.1%),
respectively (Table 1).
Diabetes
The percentage of the population defined with a fasting blood
glucose level ≥ 7.0 mmol/l or on medication for raised blood
glucose levels (age-standardised) in 2014 was 12.1% for men, and
for women 12.9%. In 2019, the age-adjusted prevalence (20–79
years old) of diabetes was 8.5%, which is higher than that of Africa
(3.9%), and slightly lower than the global level at 9.3% (Table 1).
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Part C: Clinical practice and guidelines
Health system capacity
The country had an average of 13 physicians and 25.1 nurses per
10 000 of the population in 2017, while there were 23 hospital
beds for every 10 000 people in 2015.
9
Data for locally relevant clinical tools to assess CVD risk,
12
and guidelines for the detection and management of AF
and management of acute rheumatic fever are available.
13,14
Appropriate national guidelines are available for the treatment
Table 1. Cardiovascular disease indicators for Tunisia
Indicators
Male
Female
Total
Year
Status of national cardiovascular disease epidemic
Premature CVD mortality (30–70 years) (% deaths)
–
–
11
2012
Total CVD mortality (% of deaths)
50.7
52.5
51.5 (31.8)* 2017
Total RHD mortality (% of deaths)
0.12
0.19
0.15 (0.5)*
2017
DALYs attributable to cardiovascular diseases (%)
23.8
19.4
21.9 (14.7)* 2017
AF and atrial flutter (%)
0.3
0.3
0.3 (0.5)*
2017
Prevalence of RHD (%)
0.01
0.01
0.01 (0.5)*
2017
Tobacco and alcohol
Prevalence of adult tobacco use (≥ 15 years) (%)
49.3 (36.1)** 2.9 (6.8)**
–
2018
Prevalence of youth (13–15-year-olds) tobacco use (%)
20.1 (18.2)** 3.8 (8.3)**
2010
Estimated direct (healthcare-related) cost of tobacco use in your population (in current US$)
–
–
Proportion of premature CVD mortality attributable to tobacco (%)
–
–
5 (10)**
2004
Recorded alcohol consumption per capita (≥ 15 years) (in litres of pure alcohol) (three-year average)
1.6
2016-18
Raised blood pressure and cholesterol
Population with raised BP (SBP ≥ 140 or DBP ≥ 90 mmHg) (%)
23.8 (24.1)** 22.5 (20.1)**
–
2015
Population with raised TC (≥ 5.0 mmol/l) (%)
37.3
43.8
40.7 (38.9)** 2008
DALYs attributable to hypertension (%)
13.2
12.1
12.74 (8.7)* 2017
Mortality caused by hypertensive heart disease (% of deaths)
2.7
4.7
3.55 (1.7)*
2017
Physical activity
Adolescents (11–17 years) who are insufficiently active (< 60 minutes of moderate- to vigorous-
intensity PA daily) (%)
74.1
88.2
81.4
2010
Adults (age-standardised estimate) who are insufficiently active (< 150 minutes of moderate-intensity
PA per week, or < 75 minutes of vigorous-intensity PA per week) (%)
26.4
34.1
30.4 (27.5)** 2016
Overweight and obesity
Adults who are overweight (BMI ≥ 25–< 30 kg/m
2
) (%)
57.1
65.8
61.6 (38.9)** 2016
Prevalence of obesity (BMI ≥ 30 kg/m
2
) (%)
19.1
34.3
26.9 (13.1)** 2016
Diabetes
Defined population with fasting glucose ≥ 126 mg/dl (7.0 mmol/l) or on medication for raised blood
glucose (age-standardised) (%)
12.1 (9)*
12.9 (8)**
–
2014
Prevalence of diabetes (20–79 years) (%)
–
–
8.5 (9.3)
#
2019
CVD, cardiovascular disease; RHD, rheumatic heart disease; DALYs, disability-adjusted life years; AF, atrial fibrillation; SBP, systolic blood pressure; DBP, diastolic
blood pressure; TC, total cholesterol; PA, physical activity; BMI, body mass index.
*IHME global data exchange
8
**WHO global data
9
#
IDF Diabetes Atlas
.
11