Abstract
BackgroundLittle is known about heart diseases and their treatment in rural sub-Saharan Africa. This study aimed to describe the occurrence, characteristics, and etiologies of heart diseases, and the medication taken before and prescribed after echocardiography in a rural referral Hospital in Tanzania.MethodsThis prospective descriptive cohort study included all adults and children referred for echocardiography. Clinical and echocardiographic data were collated for analysis.ResultsFrom December 2015 to October 2017, a total of 1’243 echocardiograms were performed. A total of 815 adults and 59 children ≤15 years had abnormal echocardiographic findings; in adults 537/815 (66%) had hypertension, with 230/537(43%) on antihypertensive drugs, and 506/815 (62%) were not on regular cardiac medication; 346/815 (42%) had severe eccentric or concentric left ventricular hypertrophy, and 182/815 (22%) had severe systolic heart failure. Only 44% demonstrated normal left ventricular systolic function. The most frequent heart diseases were hypertensive heart disease (41%), valvular heart disease (18%), coronary heart disease (18%), peripartum cardiomyopathy (7%), and other non-hypertensive dilated cardiomyopathies (6%) in adults, and congenital heart disease (34%) in children. Following echocardiography, 802/815 (98%) adults and 40/59 (68%) children had an indication for cardiac medication, 70/815 (9%) and 2/59 (3%) for oral anticoagulation, and 35/815 (4%) and 23/59 (39%) for cardiac surgery, respectively.ConclusionHypertension is the leading etiology of heart diseases in rural Tanzania. Most patients present with advanced stages of heart disease, and the majority are not treated before echocardiography. There is an urgent need for increased awareness, expertise and infrastructure to detect and treat hypertension and heart failure in rural Africa.
Highlights
Non-communicable diseases are underappreciated in countries with a low-middle sociodemographic index (SDI), even though disability adjusted life-years (DALYs, the sum of the years of life lost due to premature mortality and years of life lived with disability) due to noncommunicable diseases increased by 54% during the last 25 years [1]. DALYs from communicable, maternal, and nutritional diseases still account for more than those from non-communicable diseases in sub-Saharan Africa, cardiovascular diseases are increasingly present among the leading causes of total DALYs in countries with a low SDI [1]
802/815 (98%) adults and 40/59 (68%) children had an indication for cardiac medication, 70/815 (9%) and 2/59 (3%) for oral anticoagulation, and 35/815 (4%) and 23/59 (39%) for cardiac surgery, respectively
Most patients present with advanced stages of heart disease, and the majority are not treated before echocardiography
Summary
Non-communicable diseases are underappreciated in countries with a low-middle sociodemographic index (SDI), even though disability adjusted life-years (DALYs, the sum of the years of life lost due to premature mortality and years of life lived with disability) due to noncommunicable diseases increased by 54% during the last 25 years [1]. DALYs from communicable, maternal, and nutritional diseases still account for more than those from non-communicable diseases in sub-Saharan Africa, cardiovascular diseases are increasingly present among the leading causes of total DALYs in countries with a low SDI [1]. The most commonly reported etiology of heart failure in low- and middle-income regions is ischemic heart disease, except for the Americas and Africa, where hypertension is the predominant cause [4]. Most patients included were from urban hospitals, and only a minority (603/10’098, 6%) originated from rural areas, where cardiomyopathies and rheumatic heart disease appeared to be most common causes for heart failure in small studies from rural Rwanda and rural Cameroon [6, 7]. We describe the occurrence, characteristics, and etiologies of heart diseases diagnosed using echocardiography in patients from the rural Kilombero- and Ulanga districts in Tanzania, and describe the medication taken before and prescribed after echocardiography. This study aimed to describe the occurrence, characteristics, and etiologies of heart diseases, and the medication taken before and prescribed after echocardiography in a rural referral Hospital in Tanzania
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