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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018
262
AFRICA
Feasibility of south–south collaboration in Africa:
the Uganda–Mozambique perspective
Judith Namuyonga, Peter Solomon Lwabi, John Omagino, Magdi Yacoub, Ana Olga Mocumbi
Keywords:
cardiovascular research, south–south partnerships,
Uganda–Mozambique
Cardiovasc J Afr
2018;
29
: 262–263
www.cvja.co.zaDOI: 10.5830/CVJA-2018-030
Existing collaborations in health have been common between
developed countries (north) and low-income countries (south).
Not only have such partnerships developed capacity in African
institutions, they have also enhanced skills transfer and increased
research.
1
Uganda and Mozambique are low-income countries (LICs)
located in the eastern part of the African continent that have
much in common. The health budgets of both countries are less
than 15%, as documented in the Abuja Declaration by African
heads of state and the World Health Organisation.
2
High infant and maternal mortality rates occur in these
nations, as well as chronic diseases of poverty such as rheumatic
heart disease (RHD) and endomyocardial fibrosis (EMF),
among others.
3,4
We report here on an experience of collaboration
between two institutions from these LICs using small budgets for
mentorship in research and speciality training, with a focus on
poverty-related cardiovascular diseases.
Existing partnerships
The Uganda Heart Institute (UHI) is the only centre in Uganda
mandated by an act of parliament to offer cardiovascular services,
including diagnosis, open-heart surgery and training of doctors,
nurses and other health professionals. The Institute has had some
collaboration with foreign teams from the USA and UK.
5
On the other hand, Mozambique has a heart institute
that functions as a private not-for-profit organisation, and a
national referral public hospital, both offering comprehensive
cardiovascular services, including catheterisation laboratories and
open-heart surgery, supported by collaborations with universities
and hospitals from the UK, Switzerland, Portugal, France,
USA and Spain.
1
Mozambique has also prioritised research into
neglected cardiovascular diseases through its National Health
Institute and the Eduardo Mondlane University.
Rationale
One of the most neglected cardiovascular diseases, EMF,
is prevalent in certain areas of Mozambique and Uganda,
where it is an important cause of heart failure. This restrictive
cardiomyopathy usually affects underprivileged young people
living in remote rural areas.
Whereas Uganda pioneered EMF-related research in the
40s,
6
the most recent studies have emerged in Mozambique, in
a rural coastal district of Inharrime, near Maputo.
4
EMF was
first described in Uganda by Davies in 1948,
6,7
who reported
biventricular involvement in over 50% of the autopsies and a 14%
prevalence. In the 1970s, Somers and colleagues demonstrated a
familial component of EMF.
8
More recently, Mocumbi
et al.
used portable cardiac
ultrasound to assess EMF prevalence in the general population
in Inharrime, which was found at 18.9%.
3
Diagnostic criteria are
currently based on echocardiography,
4
which increases sensitivity
and is becoming increasingly accessible in the affected countries.
The aetiology of EMF has been linked to genetic and
environmental factors,
4,9
but the exact cause of the disease
remains unknown. Clinical features depend on the severity
of the disease
10
and how affected the ventricles are, and
characteristically include prominent ascites disproportionate to
little or no lower-limb oedema. Death usually results from heart
failure, thromboembolism and arrhythmias.
11
Among individuals with advanced disease, surgery has shown
substantial benefits,
12
but remains challenging and palliative, as it
improves symptoms only, carrying high morbidity and mortality
rates.
13
Therefore, visiting teams to endemic areas are not keen to
operate on such cases.
Mozambique–Uganda collaboration: feasibility
study on 10-year follow up of EMF
While cases of EMF in Uganda seem to have reduced over the
years, the reverse is true in Mozambique. A comprehensive
programme has been started by Mozambique to understand the
epidemiology, clinical characterisation and natural history of the
disease, and to explore new therapeutic options.
Teams of the UHI and NPHI (National Public Health
Institute) decided to exchange knowledge by starting a
collaborative project with both training and research arms.
A paediatric cardiologist (Judith Namuyonga) from the UHI
Paediatric Cardiology Department, mentored by Peter Lwabi,
had a placement arranged in Mozambique’s NPHI, under the
mentorship of the local principal investigator and paediatric
Uganda Heart Institute Ltd, Kampala, Uganda
Judith Namuyonga, MB ChB, MMed, F paed cardiology, jnamuyon-
ga@gmail.comPeter Solomon Lwabi, MB ChB, MMed, FCard
John Omagino, MB ChB, MMed, F Cardiac Surgery
Imperial College of London, UK; Aswan Heart Centre,
Cairo, Egypt
Magdi Yacoub, MB ChB, MMed, F Cardiac Surgery, PHD
Mozambique Institute of Health Education and Research
(MIHER); Instituto Nacional de Saúde; Universidade
Eduardo Mondlane, Maputo, Mozambique
Ana Olga Mocumbi, MB BCh, FRCS, PhD