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SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 15 NUMBER 1 • JULY 2018
13
Prevalence, awareness, treatment and control of
hypertension, diabetes and hypercholesterolaemia among
adults in Dande municipality, Angola
João M Pedro, Miguel Brito, Henrique Barros
Correspondence to: João M Pedro
CISA, Centro de Investigação em Saúde de Angola, Caxito, Angola
email:
joao.almeidapedro@cisacaxito.orgMiguel Brito
Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de
Lisboa, Lisboa, Portugal
Henrique Barros
Faculdade de Medicina, Universidade do Porto, Porto, Portugal
Previously published in
Cardiovasc J Afr
2018;
29
: 73–81
S Afr J Diabetes Vasc Dis
2018;
15
: 13–22
Abstract
Objectives:
To estimate the prevalence, awareness, treatment
and control of hypertension, diabetes and hypercholesterol-
aemia in an Angolan population aged 15 to 64 years and to
determine relationships with sociodemographic, behavioural
and anthropometric characteristics.
Methods:
A total of 2 354 individualswere assessed for behav-
ioural, sociodemographic and physical characteristics in a
cross-sectional, community-based survey. Post-stratification
survey weights were applied to obtain prevalence levels.
Adjusted odds ratios for each variable related to the condi-
tions were calculated using logistic regression models.
Results: Overall, the prevalence of hypertension was 18.0%,
diabetes 9.2% and hypercholesterolaemia 4.0%. Among
hypertensive individuals, the awareness rate was 48.5%;
15.8% were on treatment and 9.1% had their blood pressure
controlled. Only 10.8% were aware they had diabetes,
4.5% were on treatment and 2.7% were controlled. The
awareness level for hypercholesterolaemia was 4.2%, with
1.4% individuals on treatment and 1.4% controlled.
Conclusions:
The prevalence levels of hypertension and
diabetes, which were higher than previous findings for the
region, together with the observed low rates of awareness,
treatment and control of all conditions studied, constitute an
additional challenge to the regional health structures, which
must rapidly adapt to the epidemiological shift occurring in
this population.
Keywords:
epidemiology, hypertension, diabetes, hypercholester-
olaemia, sub-Saharan Africa
Cardiovascular disease (CVD), a major cause of non communicable
diseases (NCDs), was responsible for 17.5 million deaths worldwide
in 2012, most occurring in low- and middle-income countries
(LMIC). In Africa, the frequency of NCDs is rising rapidly, reflecting
the combined effect of population growth and ageing, as well as
nutritional and epidemiological transitions.
1
A large proportion of CVD is the result of exposure to modifiable
risk factors (tobacco and alcohol consumption, unhealthy diet
and physical inactivity), which influence metabolic pathways
and ultimately result in obesity, hypertension, diabetes or
hypercholesterolaemia.
1,2
Together, these known adverse conditions
explain approximately half of CVD cases, as demonstrated in the
MONICA project and the INTERHEART study.
3,4
Among the African population participating in the INTERHEART
study, five risk factors (smoking, diabetes, hypertension, abdominal
obesity and an elevated apolipoprotein B to apolipoprotein A-1
ratio) accounted for 89.2% of the population-attributable risk for
the first myocardial infarction.
5
The same study suggested that uncontrolled major risk factors
have a larger impact on the burden of CVD in Africa than elsewhere
in the world.
5
If the current trends persist, the risk of dying from NCDs will
increase in the African region. However, this rising risk could be
reversed by reaching the proposed targets for six behavioural and
physiological risk factors (tobacco and alcohol use, salt intake,
obesity and increased blood pressure and glucose levels) out of
the nine global targets proposed by the World Health Organisation
(WHO) in the Global Action Plan for the Prevention and Control of
NCD 2013–2020.
6,7
To follow the achievement of those goals, there is a need for
sound and updated epidemiological data from all regions of the
world. The majority of published studies for the African region are
conducted at hospital services, which does not allow one to detect
risk factors, awareness rates and prevalence of such conditions
in the general population.
8-10
To provide core data on established
risk factors for the major NCDs within the context of low-resource
settings, WHO designed the STEPwise approach to Surveillance
(STEPS).
11
STEPS uses a modular structure with standardised
questions and protocols, allowing adjustment of its application and
appropriate comparisons across surveys.
11
In Angola, infectious disease and maternal and child health-
related problems remain the major causes of morbidity and
mortality.
12
However, an increased burden of NCDs has been
observed, particularly CVD, which was responsible for 9% of
adult deaths in 2013.
13
Beyond general vital statistics, specific
epidemiological information on CVD risk factors in Angola is based
on only four local studies published after 2000: a survey of 667 adult
students of Health Sciences in Lubango (prevalence of hypertension
of 23.5%),
14
a study conducted among 615 active employees of
the University Agostinho Neto, Luanda (prevalence of hypertension
45.2% and hypercholesterolaemia 11.1%),
15
1 464 participants
surveyed in the Dande Health and Demographic Surveillance System
(Dande-HDSS) catchment area (23% prevalence of hypertension),
16