CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 AFRICA 181 attributed to less working time, and therefore more leisure time to watch and listen to mass media tools.20 In contrast, Cameroonian men were found to have an increased awareness of the different types of CVD compared to women,17 and unexpectedly, the awareness of menopause, low oestrogen levels and hormone replacement therapy was higher in African American men than women21 Respondents in a peri-urban, low-income community in South Africa were familiar with the term hypertension yet could not provide a prescise definition or an explanation, even those who were known hypertensives.15 In Limpopo, South Africa, participants were unfamiliar with the term hypertension due to language barriers, and hypertension was referred to as ‘high high’ and was defined as ‘a sort of stress’.19 Only two-thirds of known hypertensives in Ga-Rankuwa, South Africa, were familiar with their preceeding blood pressure measurement and the majority of Ga-Rankuwan respondents in all gender and age categories were unaware that a heart attack, angina, heart failure, stroke and kidney failure are complications of hypertension.22 In Limpopo, South Africa, genetic predisposition was not an easily accepted risk factor for hypertension due to lack of understanding of the concept of hereditary.19 IsiZulu and Sepedi translators were used due to participants not being fluent in English, therefore there is a possibility that the translators could have influenced the participants’ responses.19 These findings reveal superficial knowledge of hypertension and more work needs to be done to enforce the dangers of hypertension being the silent killer in communities to raise awareness of the importance of participating in blood pressure screening events. Only 10% of Nigerian respondants considered hypertension to be a major and potentially life-threatening condition. Approximately 5% knew that hypertension is considered a silent disease, more than half of the study population (59.7%) had never tested their blood pressure prior to the study and less than 1% of respondants knew which blood pressure values were considered high (> 140/90 mmHg).16 This is most likely due to their blood pressure values not being disclosed to them at the time of measurement, and they were just informed whether the value was normal or high.16 Other than not visiting the free clinics, the reasons for not testing their blood pressure were that the working hours of their farms coincided with the operating hours of the free clinics.16 There is therefore an urgent need to make screening sites more accessible. This can be done by setting up screening stations after working hours at various places such as malls, schools, events and various other sites. Although stroke is one of the leading causes of mortality and morbidity worldwide, with developing countries accounting for 85% of deaths globally, there is a lack of medical information and poor control of CVD risk factors, which contributes to the rising incidence of stroke.18 Stroke was generally perceived as a serious illness among most respondents. Participants in the Western Cape, South Africa, were familiar with the term stroke and many had had personal encounters with patients who suffered from a cerebrovascular accident. They understood the link between stroke and high blood pressure and some respondents associated the stroke with emotional distress and stressful situations.15 There was generally poor community awareness of the risk factors and warning signs of stroke, as the most important risk factor for stroke, namely hypertension, could not be recognised by respondents in Ghana.13 In the cross-sectional survey conducted in Uganda, 76% of the participants did not recognise stroke as a disease related to the brain.18 Smoking was the most common risk factor identified by Malaysian respondants (69.9%).11 On the contrary, in a crosssectional study conducted in central and urban Uganda, none of the participants identified cigarette smoking as a risk factor for stroke.18 Only a quarter of Tanzanian participants (25.5%) identified alcohol consumption as harmful for cardiovasclar health,2 whereas in peri-urban South African communities, the perception of harmfulness differed on the the type of alcohol consumed: alcohol consumed in affluent areas was perceived as less harmful, as it was diluted, compared to alcohol consumed by individuals of other socio-economic backgrounds (without the addition of a diluent or mixer).15 In the Ga-Rankuwa study,22 30.1% of males and 61.8% of females were considered overweight, obese or severly obese (BMI 25 kg/m2). In the male cohort, 14.6% were aware of their obesity and the majority acknowledged a connection between obesity and CVD. In the female cohort, only 29.7% perceived that they were obese.21 An alarming fact was that 59.3% of males and 51.4% of females of the overweight group perceived themselves to be underweight.22 Knowledge of certain important risk factors and lifestyle modifications were variable and inconsistent in different regions. In both Tanzania and Nigeria, the main sources of information were through friends, family members (females), radio and television (men).2,16 Only 9% of Nigerian respondents reported to have obtained medical information from healthcare workers.16 The majority (93%) of respondents in the Western Cape, South Africa, did not comprehend the concept of risk, and 7% of respondents misunderstood and conveyed that poor adherence to medication, which placed them ‘at risk’ of having a stroke.15 No clear trends in risk factors investigated with regard to educational level could be determined in Ga-Rankuwa, however, it was noted that there was a positive correlation between lack of awareness and increasing age.22 Similarly in Kuwait and Malaysia, the participants were found to be more knowledgeable about CVD if they attended higher education centres,11,20 compared to those with moderate and low levels of education. The need for educational tools and cardiovascular awareness programmes is highlighted in the study by Ahmed et al.,11 which confirmed that patients who received promotional materials, educational leaflets and social media advertisements showed more awareness of risk factors associated with heart attacks compared to those not receiving any promotional information. The majority of Ga-Rankuwa respondents in all gender and age categories were unaware of the short-term complications of diabetes mellitus, such as hypo- or hyperglycaemia and diabetic keto-acidosis, as well as long-term complications such as cardiac disease, hypertension, kidney disease, eye disease and peripheral neuropathy.22 Participants from China were found to be more aware of diabetes as a risk factor, as opposed to participants from Malaysia.11 As the burden of non-communicable diseases rises in sub-Saharan Africa, there is a need to develop new prevention strategies. These would include propagating accurate information related to the warning signs and risk factors, as better knowledge would lead to early recognition, prompt emergency reaction and a reduction in CVD morbidity rates. Knowledge, awareness and understanding are essential to motivate individuals to adopt
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