Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future

ABSTRACT

Introduction

Although cardiovascular diseases (CVDs) are among the leading causes of death in Sub-Saharan Africa (SSA), prevention is not a priority and effective treatments are not widely available. This perspective discusses the burden, challenges, and potential opportunities for improvement of CVD prevention and control efforts in SSA.

Areas covered

This paper focuses on ischemic heart disease and stroke, and their key contributors of obesity, hypertension, diabetes and dyslipidaemia which are well-established, rapidly rising, and significant contributors to disease burden in SSA. However, their prevention, detection, treatment and control of are currently disorganized, inconsistent, unreliable, and insufficient with most SSA countries not geared to respond to this growing problem. National policies are frequently lacking or, if available, remain poorly implemented, for the control of these conditions. Primary healthcare systems have not adapted to cope with these rising CVD burdens and remain weak, underfunded and under resourced. Numerous barriers at the healthcare service, healthcare provider, and patient levels prevent optimal CVD risk factor care.

Expert opinion

Innovative approaches such as task-shifting with the reallocation of care to lower-level healthcare workers and the potential use of inexpensive technological options should be encouraged to provide equitable CVD preventive and curative solutions to SSA’s poor.

KEYWORDS:

• Africa
• cardiovascular diseases
• cholesterol
• diabetes
• heart attack
• hypertension
• lipids
• obesity
• primary healthcare
• stroke

ARTICLE HIGHLIGHTS

• Cardiovascular diseases (CVDs), with the need for ongoing chronic care over a prolonged period, is placing considerable demands, including financial, on governments, healthcare systems, patients and their families in Sub-Saharan Africa (SSA).

• Despite the growing awareness of the mounting burden of CVD risk factors such as obesity, hypertension, diabetes, and dyslipidemia in SSA, investment and efforts do not correspond with the magnitude of the challenges.

• The management of CVDs in SSA is suboptimal and attributable to a multitude of factors including insufficient resources, inadequate healthcare systems, absence of affordable medications and non-existent effective preventive strategies at the population level.

• Healthcare policies pertaining to CVD management guidelines, service provision and resource allocation for staffing and skills development, infrastructure provision and equipping of clinics, among other considerations, are needed to strengthen healthcare systems for delivery of optimal, accessible, and affordable CVD care.

• Innovative solutions such as task-shifting of CVD risk factor care to lower-level healthcare workers, with a well-designed training program that imparts the appropriate skills and knowledge, has the potential to strengthen health system effectiveness and reduce the pressure experienced at primary healthcare facilities.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.