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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
50
VOLUME 14 NUMBER 2 • DECEMBER 2017
Prevalence of selected cardiometabolic risk factors
among adults in urban and semi-urban hospitals in four
sub-Saharan African countries
Samuel Kingue, Solofonirina Rakotoarimanana, Nirina Rabearivony,
Francois Lepira Bompera
Correspondence to: Samuel Kingue
Department of Cardiology, Faculty of Medicine of Yaounde,
General Hospital of Yaounde, Yaounde, Cameroon
e-mail:
samuel_kingue@yahoo.frSolofonirina Rakotoarimanana, Nirina Rabearivony
Department of Cardiology, Joseph Raseta Defelatalala University Hospital,
Antananariv, Madagascar
Francois Lepira Bompera
Division of Nephrology, Department of Internal Medicine,
University Clinic, Democratic Republic of Congo
Previously published in
Cardiovasc J Afr
2017;
28
: 147–153
S Afr J Diabetes Vasc Dis
2017;
14
: 50–56
Abstract
Aim:
Cardiovascular diseases (CVDs) are a global challenge
but the burden in sub-Saharan African (SSA) countries is less
well documented than elsewhere. We aimed to describe the
key cardiometabolic risk factors in four SSA countries.
Methods:
A cross-sectional, multi-national, hospital-based
study was carried out among adults (> 35 years) across four
SSA countries from12 December 2011 to 7 February 2013. Risk
factors were defined using the World Health Organisation
and International Diabetes Federation guidelines.
Results:
Of the 844 adults (57.4% female, mean age 52.6
years), 76.6% were urban residents. The predominant CVD
risk factors were hypertension (74.1%), obesity (36.2%) and
excessive alcohol consumption (25.6%). Diabetes (17.7 vs
10.0%), obesity (42.8 vs 16.8%) and hypercholesterolaemia
(25.8 vs 18.0%) weremore prevalent among the hypertensive
subjects (all
p
< 0.007) than the normotensives. The metabolic
syndrome (39.4%) was more common in women and hyper-
tensive subjects.
Conclusions:
Hospital patients in SSA countries present with
excessive rates of cardiometabolic risk factors. Focus on their
prevention and control is warranted.
Keywords:
cardiovascular risk factors, metabolic syndrome, sub-
Saharan Africa
Non-communicable diseases (NCDs) are rapidly increasing in
incidence in sub-Saharan Africa (SSA). Cardiovascular disease
(CVD) is the leading contributor to the global burden of NCDs.
1
Hypertension, which is themain driver of CVD, has been estimated to
affect about 972 million adults worldwide, a figure that is projected
to increase by 60% by the year 2025.
2,3
This high prevalence of
hypertension is coupled with poor detection, treatment and control
rates.
4
Diabetes mellitus is also a leading cause of morbidity andmortality
fromNCDs and a major precursor of CVD.
5
The population of people
with diabetes in SSA is growing more rapidly than anywhere else,
and is expected to nearly double within the next two decades.
6
The
co-occurrence of diabetes and hypertension in the same individual
compounds the harmful effects of each condition.
A recent cross-sectional study conducted in semi-urban
Cameroon has indicated the co-occurrence of diabetes and
hypertension, affecting up to 5% of adults.
7
Other common drivers
of NCDs and the CVD burden include physical inactivity, smoking,
unhealthy diet, dyslipidaemia, excess weight and alcohol abuse.
8,9
Monitoring the risk profile of the population is an extremely
important component of the strategy to prevent and control NCDs
in general and CVD in particular. This pivotal role was recently
highlighted in the World Health Organisation (WHO) global action
plan of 2013–2020 for the prevention of NCDs.
10
Given the silent
nature of hypertension and other risk factors, and the lack of
awareness of them in low- and middle-income countries (LMICs),
opportunistic screening and awareness have been highlighted by
the World Heart Federation as the key first steps to improving
management and prevention.
11
Studies addressing the risk profile of individuals who have contact
with hospitals in Africa are lacking, and most of the existing studies
are single-country studies, therefore offering less opportunity to
examine between-country variabilities. This report is on a multi-
country, multi-centre, health facilities-based study to assess the
distribution of major cardiometabolic risk factors in adults in urban
settings across different countries in SSA.
Methods
This was a multi-national, multi-centre, cross-sectional study
conducted from 12 December 2011 to 7 February 2013. The
following SSA countries participated in the study: Cameroon (13
centres), Nigeria (five centres), Democratic Republic of Congo
(DRC) (11 centres) and Madagascar (24 centres). The study
centres were purposefully selected from the health districts of
the capital cities (urban and semi-urban) in the participating
countries. Participating centres included both public and private
healthcare facilities. General practitioners working in the selected
centres were trained to consecutively recruit all individuals aged
over 35 years to their facilities, regardless of the reason for the
visit to hospital, if they were resident in the particular city for at
least three months.
Ethical approval was obtained from the ethics committees of the
participating countries and the patients gave written consent before