Echocardiography: a tool to foster research into neglected cardiovascular diseases in Africa

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Research in wealthy countries has been co-funded by the government and the industry, allowing spectacular discoveries in molecular biology, chemistry and engineering, which are then taken to the pharmaceutical industry and applied to the development of drugs and devices for a wide range of diseases, leading to a decrease in mortality in developed countries. Unfortunately, most benefits of these gains for human kind are not available in most parts of Africa, a continent with low life expectancy associated with an extremely high burden of diseases that have been controlled in other parts of the world. Cardiovascular diseases are the primary noncommunicable health problem in Africa, and according to The World health report 2001 they accounted for 9.2% of the total deaths in the African Region in 2000 [1]. If we consider that research efforts targeted at a disease should ideally be in proportion to its global health impact, several diseases affecting the heart in most parts of Africa are neglected. Indeed, several conditions that affect millions of people and cause high morbidity and mortality, are not the subject of comprehensive research programmes mainly because they are confined to areas that have suffered chronic lack of incentives for research and development. The lack of scientific interest in neglected tropical diseases is confirmed if we compare the low scientific output on these conditions in the PubMed or the Web of Science, with that of matched diseases with comparable DALYs [2]. This remains the case for rheumatic heart disease, cardiomyopathies that affect predominantly the African population (such as the case of endomyocardial fibrosis and peripartum cardiomyopathy), and infectious diseases with cardiovascular manifestations such as tuberculosis and schistosomiasis, which are highly prevalent in Africa [3, 4]. While complications of untreated congenital heart diseases are responsible for considerable morbidity and mortality in children and young adults who live for years without diagnosis and/or cannot be surgically treated due to lack of facilities and human expertise, new challenges are feared with the growing threat imposed by cardiac disease related to HIV infection and antiretroviral therapy. Finally, there is an increasing importance of ischemic heart disease, partially due to the increased prevalence of hypertension, smoking, obesity, hyperlipidemia and adoption of western life-style in some urban areas [1]. Little is known about the epidemiology of cardiovascular neglected diseases, which continue to be largely underdiagnosed. Although affecting large segments of the population and imposing a high burden to the African communities, these conditions are perceived to be less important than other health problems. Statistical information on these conditions A. O. Mocumbi (&) Instituto do Coracao, Maputo, Mocambique e-mail: amocumbi@yahoo.com