Trends in cardiovascular diseases and associated risks in sub-Saharan Africa: a review of the evidence for Ghana, Nigeria, South Africa, Sudan and Tanzania

Figures & data

Figure 1. PRISMA flow chart.

Table 1. Characteristics of the reviewed publication.

Classification category	Subcategories	Number of publications^a	References number
Year of publication	2016 to present	9	[7–15]
	2013–2015	23	[16–38]
	2010–2012	20	[39–58]
	Not presented	–	–
Year of data collection	2010 to present	18	[10,12,14,15,19–23,27,29,33,36,37,39,51,53]
	2000–2009	19	[13,18,25,27,29–36,42,44,46,47,50,57,58]
	1990–1999	4	[21,30,34,46]
	Before 1990	3	[39,50,53]
	Not presented	18	[7–9,11,16,24,26,28,38,40,41,43,45,48,49,52, 55,56]
Origin of publication	South Africa	5	[8,34,39,48,55]
	Sudan	8	[10,11,14,22,37,41,56,57]
	Ghana	8	[13,15,19,21,23,35,44,50]
	Nigeria	29	[9,12,20,21,24–33,36,38,45–47,49,51–54,58]
	Tanzania	2	[18,42]
Number of countries included in the review	Single country	51	[7–20,22–58]
	Several countries	1	[21]
Publication objective	Descriptive	34	[7–10,12,14,16,18,19,20,22–29,31–34,38,42–45,47,49,50,52,55,57,58]
	Explanatory	13	[8,11–13,17,21,35,37,39–41,48,56]
	Exploratory	7	[34,36,46,47,50,51,54]
	Not stated explicitly	3	[15,30,53]

^a One publication can be associated with more than one subcategory.

Table 2. Specificities of the study design.

Classification category	Sub-categories	Number of publications^a	References number
Study design	Systematic review	9	[15,19,21,39,46,50,52,53,56]
	Cross-sectional study	27	[7–9,11–13,17,20,22,23,24,26,28,31,34,35,37,38,40,41,43,45,47,49,54,57,58]
	Cohort perspective	5	[16,29,33,42,48]
	Cohort retrospective	8	[14,19,25,27,32,36,44,51]
	Case-control	4	[10,18,30,55]
	Not presented	–	–
Study population	General population	9	[7,16,18,23,28,31,34,44,58]
	Specific population sub-group	35	[8–14,17,19,20,22,24–27,29,30,32,33,35–38,40–43,45,47–49,51,54,55,57]
	Not presented	8	[15,21,39,46,50,52,53,56]
Sample area	National	1	[28]
	District/s - city/ies	43	[7–14,16–20,22–27,29–38,40–45,47–49,51,54,55,57,58]
	Not presented	8	[15,21,39,46,50,52,53,56]
Sample size	Larger than 4000 respondents	2	[25,36]
	3001–4000 respondents	3	[13,32,51]
	2001–3000 respondents	3	[7,19,28]
	1001–2000 respondents	9	[24,31,34,35,40,43,44,54,57]
	1000 respondents or smaller	27	[8–12,14,16–18,20,22,23,26,27,29,30,33,37,38,41,42,45,47–49,55,58]
	Not presented	8	[15,21,39,46,50,52,53,56]
Data collection method	Administrated questionnaire	14	[12,16,20,22,23,26,28,31,38,40,43,45,47,49]
	Structured questionnaire	15	[8,10,11,13,19,24,34,37,41,44,48,54,55,58]
	Semi structured questionnaire	1	[17]
	Structured interview	3	[9,18,42]
	Patient record	11	[14,25,27,29,30,32,33,35,36,51,57]
	Existing dataset (e.g., national surveys, reports, articles, disease registry data, vital registration)	8	[15,21,39,46,50,52,53,56]
	Clinical laboratory test	1	[7]
Data analysis method	Tests for association/ correlation	12	[8,11,12,23,28,31,36,40,43,47,55,58]
	Non-parametric test	11	[18,22,23,25,29,31,34,38,41,49,55]
	Regression	15	[9–11,17,18,23,24,28,29,34,42–45,47,49,51,55]
	Estimations	8	[13,26,29,31,51]
	Hypothesis testing	1	[49]
	Descriptive Analysis	22	[7,11–13,20,24,25,28,29,32,35,36,38,39,43,45,47,48,49,51,54,58]
	Meta-analysis	3	[15,39,46]
	Other	1	[7]
	No pooled analysis	2	[21,50]
	Not clear	11	[16,14,19,27,30,33,37,52,53,56,57]
Validity, reliability and generalizability of the results	Reliability is clear	46	[7–13,15–36,38,39,41–51,53–55,58]
	Reliability is unclear	2	[14,52]
	Reliability not analyzed	3	[37,56,57]
	Validity is clear	48	[7–13,15–39,41–51,53,54,55,57,58]
	Validity is unclear	3	[14,40,52]
	Validity not analyzed	1	[18]
	Generalizability is clear	31	[7,9,11–16,18,19,21,23,24–26,28,31,32,34–36,38,39,42,43,44,45,48,49,53,54]
	Generalizability is unclear	21	[8,10,17,20,22,27,29,30,33,37,40,41,46,47,50–52,55–58]
	Generalizability not analyzed	–	–
Quality assessment grade	High	40	[7–9,12,13,15,17–29,31,32,34–36,38,39,41–51,54,55,58]
	Medium	9	[10,11,14,30,33,37,40,53,57]
	Low	2	[52,56]

^a One publication can be associated with more than one sub-category.

Table 3. Major findings reported in the review.

Summary of major findings	Number of publications^a	References number
Changes in CVDs prevalence
Significant in general	30	[7,8,13,14,17–21,27–30,33–36,39,40,42,44,46,50–57]
Significant in some group	28	[8,9,12,14–16,20,23–27,29,31, 32,36–42,45,47,48,51,58]
Insignificant	1	[49]
Not clear	1	[43]
Not reported	2	[10,11]
CVDs country distribution
South Africa	5	[8,34,39,48,55]
Sudan	6	[14,22,37,41,56,57]
Ghana	7	[13,15,19,21,23,35,44,50]
Nigeria	30	[7,9,12,16,17,20,21,24–33,36,38,40,43,45–47,49,51–54,58]
Tanzania	2	[18,42]
CVDs risk conditions
Hypertension	40	[7–11,13,14,16–21,23–25,27,29–32,34,37,38,40–46,48–56]
Diabetes Mellitus	11	[7,16,20,27,30,31,37,40,42,52,56]
Obesity/overweight	24	[8,12–17,19,21,23,28,30,34,37,38,41–43,45,47–49,52,58]
Others	12	[8–10,14,15,20,22,24,30,33,34,55]
Not clear	–	–
Not reported	4	[26,35,36,39]
Major CVDs estimated health burden
Rheumatic heart disease	3	[22,39,56]
Stroke	8	[18,19,27,31,42,44,51,53]
Ischemic heart disease	13	[10,14,26,27,30,33,37,52,54,55,56,57,58]
Hypertensive heart failure	5	[29,32,35,53,56]
Others	1	[56]
Not clear	27	[7,8,11–13,15–17,20,21,23–25,28,34,36,38,40,41,43,45–50]
Future health reforms/policies recommendations
Presented	3	[19,34,35]
Not presented	48	[2,7–18,20–33,36–58]
Effect of CVDs trends on health system
Development of CVDs education &  promotion program	4	[19,20,35,50]
Management program for people with or at risk of CVDs	1	[34]
Effective CVDs surveillance and monitoring programs for hypertension	–	–
CVDs Risk factors reduction and prevention	4	[19,20,34,50,56]
Process for identification of very high risk families	–	–
Improvement of CVDs related health Infrastructure (ie. Accessibility, availability, affordability)	1	[33]
Treatment availability and affordability	2	[19,20]
Research promotion	–	–
Not reported	43	[7,8,10–18,21–32,35–48,51,55,57,58]

^a One publication can be associated with more than one sub-category.

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