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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
AFRICA
39
2016 (Table 1).
6
In the 2015 STEP survey, 4% of men and 7.9%
of women were reported to be physically inactive, with an overall
prevalence of 5.8%.
13
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 20.9 and 4.5%, respectively (Table 1).
6
Women had
a higher prevalence (28%) of overweight than men (13.4%), with
a similar pattern for obesity (6.9 vs 1.9% in women and men,
respectively). According to STEPS data, far fewer men (4.4%)
and women (8.8%) were found to be overweight, while only 1.2%
of these adults had a BMI ≥ 30 kg/m
2
.
13,17
Diabetes
The percentage of the population defined with a fasting glucose
level of ≥ 7.0 mmol/l or on medication for raised blood glucose
(age standardised) in 2014 was 5.8% for men and 5.0% for
women.
6
In 2019, the age-adjusted prevalence (adults 20–79
years) of diabetes was 4.3%, which is lower than the global
prevalence of 9.3% (Table 1).
18
Adults aged 15–69 years old who
participated in the 2015 STEP survey had a higher diabetes rate
of 5.8% using WHO criteria, and 3.2% according to criteria of
the American Diabetes Association.
16,17
In their article of the
STEP survey on NCD risk factors, Gebreyes
et al
.
16
reported
9.1% of the participants had impaired fasting glucose levels
(IFG 100–125 mg/dl = 5.55–6.94 mmol/l) according to IDF
criteria, whereas, per WHO criteria, only 3.8% had intermediate
hyperglycaemia. Of these participants, 8.8% were men and 9.6%
women, with 10.4% living in urban and 8.9% in rural areas.
An increase in IFG from 9.1 to 12.1% was observed in the age
groups 15–24 years and ≥ 65 years, respectively, while those
25–34 years old had the lowest prevalence (7.8%).
Part C: Clinical practice and guidelines
Health system capacity and guidelines for NCD
risk factors
Ethiopia had an average of 0.8 physicians and 7.14 nurses per
10 000 of the population in 2018, and three hospital beds per
10 000 people in 2015.
6
In 2017, a locally relevant clinical tool
to assess CVD risk had been partially developed.
19
Ethiopia
was one of the lower-income countries to participate in the
REMEDY study that reported a hospital-based registry for
RHD and rheumatic fever.
20
Locally relevant clinical guidelines
for the management of acute rheumatic fever (ARF) and RHD
have been implemented.
21
In 2016, guidelines were developed
to address AF, pharyngitis, ARF and RHD.
22
Guidelines for
the treatment of tobacco dependence and a system to measure
the quality of care provided to people who have suffered acute
cardiac events had been noted in 2016.
22,23
Similarly, guidelines
for the detection and management of diabetes are available.
22
Essential medicines and interventions
Data on drug availability from a survey in September 2017
revealed Ethiopia had five of the eight essential medicines
available at primary-care facilities in the public health sector.
24
These were aspirin (23.08%), angiotensin converting enzyme
(ACE) inhibitors (46.15%),
β
-blockers (19.23%), metformin
(38.46%) and insulin (7.69% short acting; 11.54% intermediate
acting). However, insulin is possibly only available at primary
hospitals (Gebremichael, pers commun). Statins were only
available at 4% of Ethiopian health facilities.
25
According to
the revised National Essential Medicine List, warfarin and
clopidogrel were available.
26
National guidelines are available for
CVD risk stratification at the primary healthcare level, however,
TC measurement is only done at the secondary and tertiary
levels.
22
Secondary prevention of ARF and RHD is available in
public-sector health facilities.
27,28
Secondary prevention and management
In a single study in Bedele town in south-west Ethiopia, 11.0%
of hypertensive persons received medical treatment in 2014.
29
Among identified cases with hypertension in the STEP survey,
only 2.8% received treatment, which is lower than that reported
for other LICs.
16
In a study by Yadeta
et al
.,
30
76.1% of high-risk
patients with AF were being treated with oral anticoagulants
(OAC) in 2016. In another hospital-based study on AF patients
attending the cardiac clinic in 2019, 66% received OAC.
31
Using
the stroke risk-stratification CHA
2
DS
2
-VASc score, about 70%
of participants with AF (4.3%) were identified to take OAC in a
community-based cross-sectional study in south-west Ethiopia.
32
However, these studies do not represent national data, as
information regarding AF prevalence is scarce.
32
The percentage
of people with a history of CVD taking aspirin, statin and at
least one antihypertensive agent is unknown.
Part D: Cardiovascular disease governance
In 2010, the Federal Ministry of Health (FMoH) developed
a national strategic framework through the Health Sector
Development Program IV (HSDP IV) addressing NCD, while
previous HSDPs paid little or no attention to the prevention and
control of NCD and their risk factors.
33
The development of a
detailed national strategic action plan (NSAP) was recommended,
which was drawn up and published in 2014.
34
The strategic plan,
specifically, the Health Sector Transformation Plan (HSTP),
35
has
recently been revised and endorsed in 2020.
36
For implementing
the NSAP, there is a budget and a unit in the national MoH.
34,37
There is a CVD focal point within the NCD unit of the MoH.
Furthermore, a national surveillance system that includes CVD
and their risk factors has been implemented.
17
A national
tobacco-control strategic plan has been launched, along with a
multi-sectoral co-ordination mechanism.
19
Collaborative projects
between the MoH and non-governmental organisations and
Addis Ababa University for CVD interventions have been
reported.
38
Non-governmental expenditure on major NCD is to
a certain extent allocated to CVD healthcare,
35
and the benefits
of CVD prevention and control for population health and the
economy have been modelled.
39,40
Assessment of policy response
No legislation exists that mandates health financing for CVD
or any specific diseases, as the healthcare financing strategy