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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013
AFRICA
41
Some caveats against current and future projections of
mortality data for IHD in SSA include the use of approximations
that often embrace substantial uncertainties, especially in
the estimation of cause-specific deaths. This huge degree of
uncertainty has been attributed to a meagre database on IHD as a
specific cause of death in Africa and to the overall low coverage
of vital registration.
Despite the heavy toll inflicted by HIV/AIDS in SSA,
comparative ASMR across the continent indicate that mortality
from IHD matches and already exceeds those from HIV/AIDS
in some regions of SSA,
48,64-65
except in southern Africa, the
epicentre of the HIV/AIDS epidemic (Table 7). In Botswana
and South Africa, respectively, there were nine- and three-fold
more deaths from HIV/AIDS compared to deaths from IHD. In
Mauritius, ASMR for IHD was 274-fold higher than rates from
HIV/AIDS, and in Seychelles, the difference was 36-fold. In
Ghana, ASMR for IHD was 1.5 times that of HIV/AIDS between
2002 and 2004.
Conclusion
Nearly 40 years ago, Bradlow and colleagues
66
stated that
Africa provided a vast natural laboratory for the study of the
aetiology and epidemiology of heart disease. Little appears to
have changed in terms of the epidemiology of IHD in SSA. The
scarcity of cause-specific data makes a mockery of the case for
agitating for greater action plans to combat IHD in SSA amidst
a storm of infectious diseases such as HIV/AIDS, tuberculosis
and malaria.
We need epidemiological data to make IHD less tentative
and unconvincing to sceptics, healthcare providers and policy
makers. An important starting point is the establishment of
cardiac registries in multiple centres across the continent.
Various tertiary centres of excellence already exist in parts
of sub-Saharan Africa for care of acute coronary syndromes and
cardiac rehabilitations. However, these facilities are few and far
between and are not within the reach or affordability of all of
those who need them. As with HIV/AIDS, the fight against the
pandemic of cardiovascular diseases must concentrate on primary
prevention. Novel approaches must be developed that effectively
connect community resources with organised healthcare systems
and must integrate both behavioural and biomedical approaches.
IHD remains relatively uncommon in SSA despite an
increasing prevalence of risk factors but its incidence is rising.
The pace and direction of economic development, rates of
urbanisation and changes in life expectancy resulting from the
impact of pre-transitional diseases and violence will be major
determinants of the IHD epidemic in SSA. The best window of
opportunity for concerted action to tackle the emerging epidemic
of IHD in SSA is currently shrouded by the lingering burden of
infectious diseases.
References
1.
Kitange HM, Swai ABM, Masuki G, Kilima PM, Alberti KGMM,
McLarty DG. Coronary heart disease risk factors in Sub-Saharan
Africa: studies in Tanzanian adolescents.
J Epidemiol Commun Health
1993;
47
: 303–307.
2.
Brink AJ, Aalbers J. Strategies for heart disease in sub-Saharan Africa.
Heart
2009;
95
: 1559–1560.
3.
Commerford P, Ntsekhe M. Ischaemic heart disease in Africa: How
common is it?Will it become more common?
Heart
2008;
94
: 824–825.
4.
World Health Organization. WHO Report 2006: working together for
health.
5.
Cook AR. Notes on the diseases met with in Uganda, Central Africa.
J
Trop Med
1901;
4
: 175–178.
6.
Donnison C. Blood pressure in the African natives: its bearing upon
aetiology of hyperpiesa and arteriosclerosis.
Lancet
1929;
1
: 6–7.
7.
Yusuf S, Hawkens S, Ôunpuu S, Dans T, Avezum A, Lanas F,
et al
, on
behalf of the INTERHEART Study investigators. Effect of potentially
modifiable risk factors associated with myocardial infarction in 52
countries (the INTERHEART Study): case-control study.
Lancet
2004;
364
: 934–952.
8.
Dawber TR, Moore FE, Mann GV. Coronary heart disease in the
Framingham Heart Study.
Am J Public Health
1957;
47
(4): 4–24.
9.
Fox CS, Pencina MJ, Wilson PWF, Paynter NP, Vasan RS, D’Agostino
Sr RB. Lifetime risk of cardiovascular disease among individuals with
and without diabetes stratified by obesity status in the Framingham
Heart Study.
Diabetes Care
2008;
31
: 1582–1584.
10. World Population Prospects: The 2002 Revision Volume III: Analytical
Report. United Nations Population Prospects 2002.
11. Opie LH, Seedat YK. Hypertension in sub-Saharan African popula-
tions.
Circulation
2005;
112
(23): 3562–3568.
12. Seedat YK. Hypertension in developing nations in sub-Saharan Africa.
J Hum Hypertens
2000;
14
(10-11): 739–747.
13. Addo J, Smeeth L, Leon DA. Hypertension in sub-Saharan Africa: A
systematic review.
Hypertension
2007;
50
(6): 1012–1018.
14. Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whelton P,
et
al
. Trends in the prevalence, awareness, treatment, and control of hyper-
tension in the adult US population: data from the health examination
surveys, 1960 to 1991.
Hypertension
1995;
26
: 60–69.
15. Twagirumukiza M, De Bacquer D, Kips Jan G, de Backer G, Stichele
RV, van Bortel LM. Current and projected prevalence of arterial hyper-
tension in sub-Saharan Africa by sex, age and habitat: an estimate from
population studies.
J Hypertens
2011;
29
(7): 1243–1252.
16. Mahler DB, Waswa L, Baisley K, Karabarinde A, Unwin NC.
Epidemiology of hypertension in low-income countries: a cross-
sectional population-based survey in rural Uganda.
J Hypertens
2011;
29
: 1061–1068.
17. Ejim EC, Okafor CI, Emehel A, Mbah AU, Onyia U, Egwuonwu T,
et
al
. Prevalence of cardiovascular risk factors in middle-aged and elderly
populations of a Nigerian rural community.
J Trop Med
2011; 308687.
Epub 2011 Apr 5.
18. Edwards R, Unwin N, Mugusi F, Whiting D, Rashid S, Kissima J,
et
al
. Hypertension prevalence and care in an urban and rural area of
Tanzania
. J Hypertens
2000;
18
: 145–152.
19. Amoah AGB. Hypertension in Ghana: A cross-sectional community
prevalence study in Greater Accra.
Ethn Dis
2003;
13
(3): 310–315.
20. Cappuccio FP, Micah FB, Emmett L, Kerry SM, Antwi S, Martin-
Peprah R,
et al
. Prevalence, detection, management, and control
of hypertension in Ashanti, West Africa.
Hypertension
2004;
43
:
1017–1022.
21. Steyn K, Gaziano TA, Bradshaw D, Laubscher R, Fourie J. Hypertension
in South African adults: results from the Demographic and Health
Survey, 1998.
J Hypertens
2001;
19
: 1717–1725.
22. International Diabetes Federation.
Diabetes Atlas
, 4th edn, 2009.
23. International Diabetes Federation.
Diabetes Atlas
, 5th edn, 2011.
24. Onen CL.
Diabetes and Macrovascular Complications in Adults in
Botswana
. MD thesis 2010, Makerere University, Kampala.
25. Nambuya AP, Otim MA, Whitehead H, Mulvany D, Kennedy R,
Hadden DR. The presentation of newly diagnosed diabetic patients in
Uganda.
Q J Med
1996;
89
: 705–711.
26. Elbagir MN, Eltom MA, Mahadi EO, Berne C. Pattern of long-term
complications in Sudanese insulin-treated diabetic patients.
Diabetes
Res Clin Pract
1995;
30
: 59–67.
27. Elmahdi EM, Kaballo AM, Mukhtar EA. Features of non-insulin-
dependent diabetes mellitus (NIDDM) in the Sudan.
Diabetes Res Clin
Pract
1991;
11
: 59–63.
28. Mbanya JC, Sobngwi E. Diabetes microvascular and macrovascular
disease in Africa.
J Cardiovasc Risk
2003;
10
: 97–102.
29. Mhando PA, Yudkin JS. The pattern of diabetic complications in