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SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
and already exceeds those from HIV/AIDS in some regions of
SSA,
48,64-65
except in southern Africa, the epicentre of the HIV/AIDS
epidemic (Table 7). In Botswana and South Africa, respectively,
there were nine- and three-fold more deaths from HIV/AIDS
compared to deaths from IHD. In Mauritius, ASMR for IHD was
274-fold higher than rates from HIV/AIDS, and in Seychelles, the
difference was 36-fold. In Ghana, ASMR for IHD was 1.5 times that
of HIV/AIDS between 2002 and 2004.
Conclusion
Nearly 40 years ago, Bradlow and colleagues
66
stated that Africa
provided a vast natural laboratory for the study of the aetiology
and epidemiology of heart disease. Little appears to have changed
in terms of the epidemiology of IHD in SSA. The scarcity of cause-
specific data makes a mockery of the case for agitating for greater
action plans to combat IHD in SSA amidst a storm of infectious
diseases such as HIV/AIDS, tuberculosis and malaria.
We need epidemiological data to make IHD less tentative and
unconvincing to sceptics, healthcare providers and policy makers.
An important starting point is the establishment of cardiac registries
in multiple centres across the continent. Various tertiary centres of
excellence already exist in parts of sub-Saharan Africa for care of
acute coronary syndromes and cardiac rehabilitations. However,
these facilities are few and far between and are not within the
reach or affordability of all of those who need them. As with HIV/
AIDS, the fight against the pandemic of cardiovascular diseases
must concentrate on primary prevention. Novel approaches must
be developed that effectively connect community resources with
organised healthcare systems and must integrate both behavioural
and biomedical approaches.
IHD remains relatively uncommon in SSA despite an increasing
prevalence of risk factors but its incidence is rising. The pace
and direction of economic development, rates of urbanisation
and changes in life expectancy resulting from the impact of
pre-transitional diseases and violence will be major determinants
of the IHD epidemic in SSA. The best window of opportunity
for concerted action to tackle the emerging epidemic of IHD in
SSA is currently shrouded by the lingering burden of infectious
diseases.
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