Cardiovascular Journal of Africa: Vol 32 No 1 (JANUARY/FEBRUARY 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021

AFRICA

Cardiovascular Topics

South Afri a Country Report

PASCAR and WHF Cardiovascular Diseases Scorecard

project

Mpiko Ntsekhe, Jean M Fourie, Wihan Scholtz, Oana Scarlatescu, George Nel, Karen Sliwa

Abstract

Data collected by the Pan-African Society of Cardiology

for the World Heart Federation’s Cardiovascular Diseases

Scorecard project in Africa are presented. We summarise the

strengths, threats, weaknesses and priorities identified from

the collected data for South Africa, which need to be consid-

ered in conjunction with the associated sections in the accom-

panying infographic. Data sets that were used include open-

source data available online and government publications. In

the section on priorities and the way forward, we highlight the

multifactorial health challenges with which South Africa has

had to deal and the progress that has been made.

Cardiovasc J Afr

2021;

: 47–56

www.cvja.co.za

DOI: 10.5830/CVJA-2021-002

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 South African Heart

Association, members of PASCAR and the WHF assisted in

collating and verifying these data. Based on the collected data,

we summarise the strengths, threats, weaknesses and priorities

identified, which need to be considered in conjunction with the

associated sections in the accompanying infographic. We used

open-source data sets from the World Bank, the World Health

Organization (WHO), the Institute for Health Metrics and

Evaluation, the International Diabetes Federation (IDF) and

relevant government publications.

Part A: Demographics

According to the World Bank (2018), South Africa is an upper-

middle-income country (MIC), with 34% of its people living in

rural areas. Despite its status as an upper MIC and to appreciate

the country’s health status and challenges, it is important to

note that it also occupies the status as one of the most unequal

societies worldwide. The official unemployment rate in 2019 was

close to 30%, while there is a large income and wealth inequality

(the bottom 60% of the population hold 7% of net wealth).

4,5

Almost 19% of the population were living below the US$1.9-a-

day ratio in 2014.

Life expectancy at birth in 2018 was 60 years

for men and 67 years for women.

The general government health

expenditure was 4.4% of the gross domestic product (GDP) in

2017,

while the total government health expenditure was 8.8%

of the GDP in 2014.

In 2019, the country’s GDP per capita

was US$6 001.40, and the gross national income per capita

purchasing power parity (current international $) was US$12 530

in 2018.

Part B: National cardiovascular disease

epidemic

The national burden of cardiovascular diseases

(CVD) and risk factors for non-communicable

diseases (NCD)

South Africa reports premature death based on the sustainable

developmental goals (SDGs), target 3.4, and only addresses

premature death above the age of 30 years.

Therefore, all

premature deaths caused by, for example, unoperated or operated

congenital heart disease (CHD), rheumatic heart disease (RHD),

peripartum cardiomyopathy and other cardiomyopathies in

children, adolescents and young adults, remain unreported.

Given the significant burden of these disorders in under-30-year-

olds, there may be a significant under-reporting of premature

cardiovascular deaths in the country.

South Africa’s premature death rate attributable to CVD

(30–70 years old) was 14% in 2012, which is the highest of the

countries under investigation.

Several data sources suggest that

Division of Cardiology, Department of Medicine, University of

Cape Town/Groote Schuur Hospital, Cape Town, South Africa

Mpiko Ntsekhe, MD

Karen Sliwa, MD

South African Heart Association, Cape Town, South Africa

Mpiko Ntsekhe (vice-president and member of the Board), MD

Pan-African Society of Cardiology, Cape Town, South Africa

Mpiko Ntsekhe (secretary general south), MD

Jean M Fourie, MPhil

Wihan Scholtz, MSc,

wihan@medsoc.co.za

George Nel, MSc

Karen Sliwa-Hahnle (vice-president south), MD

World Heart Federation, Geneva, Switzerland

Oana Scarlatescu

Karen Sliwa, MD

Hatter Institute for Cardiovascular Research in Africa, Faculty

of Health Sciences, University of Cape Town, South Africa

Karen Sliwa, MD