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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
AFRICA
49
had raised TC levels (Table 1), with similar varied prevalence by
province (Limpopo 15.9% and Western Cape 39.3%).
18
Physical activity
The age-standardised estimate for adults who were insufficiently
active [< 150 minutes of moderate-intensity physical activity
(PA) per week, or < 75 minutes of vigorous-intensity PA per
week] was 38.2% (Table 1). Data from the third Youth Risk
Behaviour Survey were available for adolescents, < 13–≥ 19 years
old, who were insufficiently active.
19
Of these 10 189 participants,
42.8% had done insufficient or no PA during the week preceding
the survey, with more females (47.5%) practising a sedentary
lifestyle than adolescent males (37.7%).
19
Overweight and obesity
In 2016, more South Africans (53.8%) were overweight,
compared to most other African countries under investigation.
Only Tunisia recorded a higher prevalence rate at 61.6%. For
obesity, South Africans ranked the highest at 28.3%, followed
by Tunisia with a rate of 26.9%. These figures are also higher
than the global mean prevalence rates of 38.9 and 13.1% for
overweight and obesity, respectively.
14
Far more women than
men, respectively, were overweight (65.4 vs 40.5%) and obese
(39.6 vs 15.4%).
14
Diabetes
The percentage of the population defined with a fasting glucose
level ≥ 7.0 mmol/l or on medication for raised blood glucose
(age-standardised) in 2014 was 11.3%. In 2019, the age-adjusted
prevalence (20–79 years old) of diabetes was 12.7%, which is
much higher than the rate of 3.9% for Africa (Table 1).
20
Part C: Clinical practice and guidelines
Health system capacity and guidelines for NCD
risk factors
South Africa had an average of 9.1 physicians and 13.08 nurses
per 10 000 of the population in 2017,
14
with 18 hospital beds per
10 000 people in 2018.
21
Locally relevant clinical tools to assess
CVD risk and recent clinical guidelines for CVD prevention are
available.
22,23
National guidelines for the treatment of tobacco
dependence were compiled by the South African Thoracic
Society and endorsed by CANSA (Cancer Association of South
Africa) and TAG (Tobacco Action Group).
24
Local guidelines are
available for the management of dyslipidaemia,
25
type 2 diabetes
mellitus,
26
hypertension
27
and HF,
28
with recent updates in 2018
and 2020 for the latter. These guidelines have all been drawn up
through local associations and societies by specialists in their
respective fields, as opposed to government health agencies. For
communicable but preventable CVD, society guidelines exist for
pharyngitis, acute rheumatic fever and RHD.
29,30
South Africa
has been a leader in conducting global population studies on
RHD,
31,32
for example, the REMEDY study, which provides a
tool to measure the quality of care. Alternative models to assess
care specific to acute cardiac events has been developed, using
Discovery Health data.
33
Essential medicines and interventions
The WHO has developed an essential list of medicines
34
for
cardiovascular medication, which covers treatment for angina,
arrhythmias, hypertension, elevated lipids, HF and essential
antithrombotic, antiplatelet and thrombolytic agents. All
treatments on the list are available in public and private health
sectors. Guidance and therapy for secondary prevention of
rheumatic fever and RHD, which are also on the national
essential drugs lists, are widely available in the public health
sector, including those for CVD risk stratification and cholesterol
measurement.
30
Secondary prevention and management
Although South Africa has programmes and guidelines in place
for primary and secondary prevention and management of
CVD, available data suggest that a significant proportion of
patients who should be on appropriate secondary prevention
therapy are not. Examples include (1) the low use of statin and
antiplatelet treatment after myocardial infarction and stroke,
35
(2) the low use of penicillin prophylaxis in patients with a history
of RHD demonstrated in the REMEDY study,
36
and (3) the
finding that approximately 44% of people with hypertension
were on any treatment in 2016.
37
Part D: Cardiovascular disease governance
A national strategic plan for the prevention and control of NCD
and their risk factors has been developed, which includes CVD as
the most important of these diseases.
38
NCD have been identified
as a priority area within the national strategy, as evidenced by
the appointment of a separate deputy director general and staff
dedicated to the area. The following strategic priorities have been
identified within the NCD space in the national plan for the next
decade:
•
introducing legislation and regulation to reduce the modifi-
able risk factors for NCD
•
reducing costs and increasing the efficiency of health inter-
ventions, including providing affordable medicines, devic-
es and vaccines, essential NCD health services, including
preventative services
•
establishing comprehensive surveillance mechanisms, health
information systems, and dissemination processes to assist
policy, planning, management and evaluation of NCD
prevention and control.
38
Therefore, important national NCD surveys, such as the
SANHANES and
South African Demographic and Health
Surveys (SADHS), include data on NCD risk factors such as
hypertension, diabetes, anthropometry and tobacco smoking.
38
South Africa also tracks the CVD-related mortality rate through
a regional and national death register, co-ordinated by Statistics
South Africa.
39
Although preventative strategies have been
developed for rheumatic fever and RHD, South Africa has fallen
short in its control efforts, and implementation thereof has been
inadequate.
40
In South Africa, the Tobacco Products Control Act 83 of
1993 was the first tobacco-control law and has been amended
over time, the latest being in 2018.
41,42
A summary of the latest
Control Tobacco Products and Electronic Delivery Systems Bill,
published in the Government Gazette on 9 May 2018, covers