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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
AFRICA
51
The vision of the National Development Plan is to have
significantly reduced the prevalence of NCD by 28% in 2030
through health promotion and wellness strategies.
62,67,72
The
NDoH’s Healthy Lifestyle campaign aims to promote healthy
lifestyles through interventions that address inadequate nutrition,
physical inactivity, alcohol abuse, tobacco smoking, high BP
and diabetes to reduce CVD risk.
61
Every 10 years, a national
surveillance system such as the SADHS or SANHANES, which
includes CVD and their risk factors, is implemented.
38
Various clinical guidelines have been introduced to manage
the underlying NCD risk factors in the prevention of CVD and
other related diseases.
21-29
South Africa is one of the African
countries that has introduced taxes on unhealthy foods or SSB.
73
This introduction of a tax on SSB in April 2018 was a small
victory in the fight against obesity. According to Professor
Hofman, director of PRICELESS SA (Priority Cost Effective
Lessons for Systems Strengthening) at the Wits School of Public
Health, taxing should reduce the intake of harmful products
through increasing the price. Hofman also advocated that
advertising to children, in particular, needs attention.
74
South Africa has a well-developed regulatory standards
system that oversees the labelling and marking requirements.
60
However, Hofman asks for clear front-of-package (FOP)
labelling.
74
Hofman was quoted saying ‘There are three ways
to curb nutrition-related NCDs in South Africa: [the] tax on
unhealthy foods, halting of marketing of unhealthy foods and
transparency about what people are eating.’
74
Threats
The use of reporting protocols designed for diseases prevalent
in high-income countries has meant that conditions affecting the
poorest billions in the world have been omitted or undercounted
in low- and middle-income countries. The recently published
Lancet NCDI PovertyCommission, ‘Bridging the gap in universal
health coverage for the poorest billion,’
75
highlights that reporting
premature death based on the SDG target 3.4 is inadequate for
most of Africa. The reason being that only premature deaths
above age 30 years are reported.
7,75
This inadequate definition
for premature death is pronounced in regions with high poverty
levels and a high burden of deaths among children and young
people younger than 30 years old. These premature deaths are
mostly caused by CHD, RHD, peripartum cardiomyopathy
76
and
other cardiomyopathies. Under-reporting remains a great threat
to addressing CVD in South Africa because one cannot act on
preventing future deaths if these are not reported.
South Africa’s premature CVD mortality rate at 14% is
higher than its neighbouring country, Mozambique (8%), and
most other African countries under review. The WHO-CHOICE
project that assists countries with health policy and planning
has flagged South Africa’s very high adult and high child
CVD mortality rates as a foremost priority, which needs to be
addressed.
77
Of concern is that premature mortality is not limited
to CVD, the risk of premature NCD mortality is similar to
that of Sudan (26%), and is also higher than most of the other
countries and neighbouring Namibia (21%).
78
Although dated, in 2004, the proportion of premature
CVD mortality attributable to tobacco was very high at 18%,
compared to the other African countries. The
prevalence of
tobacco use among men (46.8%) and women (16%) in 2018 was
higher than the global levels at 36.1 and 6.8%, respectively.
14
In
a recent article, researchers noted the total cost of smoking in
South Africa in 2016 amounted to US$2.27 billion, of which
about a third went to in- and out-patient healthcare.
15
In 2013,
disease-related tobacco use was estimated to cost R1.2 billion.
24
The percentage of deaths caused by tobacco was 10.11% in 2016,
killing 550 men every week, and requiring action by government
and other related organisations.
13
The data for alcohol consumption and its health consequences
remain a concern and threat to the nation’s health. A high
alcohol-attributable fraction to road traffic injuries (25.2%), liver
cirrhosis (43.4%),
79
along with being the fourth largest risk factor
contributing to death and disability, all point to significant work
needed to reduce the alcohol-related burden.
Raised BP of South African men and women is a concern
for developing CVD, as the prevalence is higher than the global
figure of 22.1%.
14
Although, the SANHANES researchers
reported lower national TC levels, in some provinces such as the
Western Cape, the women (39.3%) presented with levels higher
than those of the WHO global data (38.9%) (Table 1).
14,18
Of
the defined population, 11.3% had raised blood glucose levels,
while the prevalence of diabetes more than doubled over two
years in 2019 from 5.5 to 12.7%, also creating an increased risk
for CVD.
14,20
Obesity, which is not only the result of physical inactivity but
also poor eating habits, gives rise to a high diabetes prevalence.
In a recent joint statement, leaders of the WHF and the World
Stroke Organization urged governments to move away from the
widely adopted approach of addressing clinical factors such
as hypertension, obesity and physical inactivity individually
in isolation.
80
They advocate for a far broader approach by
following the population-wide strategy.
80
Vorster
et al
.
81
acknowledged that in light of starvation, the
global obesity epidemic demonstrates a ‘worldwide failure to
attain the goal of optimal nutrition for everyone.’ Focus on
the food and beverage industry has increased because of food
marketing to children being considered as partially responsible
for childhood obesity.
82
RHD remains a threat in Africa and developing countries.
In a cost-effective strategy, it was suggested that all children
presenting with pharyngitis be treated with penicillin without a
throat culture, which could be costly.
83
A systematic review
9
and
another on CVD, HF, IHD, cerebrovascular disease and other
related risk factors, such as hypertension, pose even higher risks
for developing CVD in South Africa and many other African
countries.
10
Professor Hofman mentioned that a study conducted by
the American Chamber of Commerce determined that NCD
will cost the South African economy 7% of the GDP by 2030.
These diseases have debilitating effects on the quality of life and,
ultimately, result in death.
84
Weaknesses
South African pharmaceutical policies do not meet the lowest
prices of those achieved internationally for affordable essential
CVD medicines.
48
Although the Essential Medicines List
at primary healthcare level contains diabetes type 1 and 2
medication (insulin, metformin), insulin is not available at most
clinics.
67
Warfarin is the most widely used anticoagulant in the