Abstract
Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008–2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.
Highlights
Most low-to-middle-income countries (LMICs) are undergoing epidemiological transition.Improvements in healthcare provision and control of infectious diseases—notably HIV/AIDS in some countries in sub-Saharan Africa (SSA)—are increasing life expectancy and the ageing population [1].This may increase the burden of non-communicable diseases (NCDs), as older people are more vulnerable [2]
The rising prevalence of NCDs is overlapping with high levels of infectious diseases, including HIV/AIDS and tuberculosis, resulting in an unprecedented burden on the healthcare system
The limited evidence and low cardiovascular disease (CVD) utilization levels are worrying in the backdrop of the rising prevalence of CVD risk factors, poor treatment and control of risk factors among the minority screened for risk factors, and the increasing burden of CVD in SSA [41,42]
Summary
Improvements in healthcare provision and control of infectious diseases—notably HIV/AIDS in some countries in sub-Saharan Africa (SSA)—are increasing life expectancy and the ageing population [1]. This may increase the burden of non-communicable diseases (NCDs), as older people are more vulnerable [2]. Urbanization and lifestyle changes occurring in SSA are predisposing young adults to NCDs, cardiovascular diseases (CVDs) [3,4]. The rising prevalence of NCDs is overlapping with high levels of infectious diseases, including HIV/AIDS and tuberculosis, resulting in an unprecedented burden on the healthcare system. Cardiovascular diseases pose major challenges to households and health systems.
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