Abstract:
Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa
(SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal,
neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, cur-
rent evidence suggests that SSA is now at the dawn of the epidemiological transition with
contemporary double burden of disease from NCDs and communicable diseases. In SSA, car-
diovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for
approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease
(IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke
and hypertensive heart disease from statistical models, real field data suggest IHD rates are
still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and
rheumatic heart disease as well as congenital heart diseases remain unconquered. While the
underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA
the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease,
and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages
in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering
primary and secondary prevention of CVDs in SSA include insufficient health care systems and
infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate
prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with
rarity of health insurance systems. This review gives an overview of the descriptive epidemi-
ology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their
management and making recommendations.
Highlights:
- The burden of non-communicable diseases including cardiovascular diseases is rising in SSA.
-
Levels of hypertension diagnosis, treatment, and control are low at <40%, <35%, and
10–20%, respectively, and more than 40% of patients with diabetes are not aware of their
diagnosis in SSA.
- SSA has 23% of the world’s prevalent rheumatic heart disease cases.
- The leading causes of heart failure in SSA are hypertensive heart disease, cardiomyopathy,
and rheumatic heart disease, with ischemic heart disease accounting for <10% of cases
compared to >50% in high-income countries.
