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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
20
VOLUME 15 NUMBER 1 • JULY 2018
hypertensive individuals and medical follow up after the first survey
in 2011.
Nonetheless, the levels of awareness about hypertensive status
are still low, a situation common in Africa,
33
with levels much lower
than those in North America and Europe.
34
A similar framework
exists for diabetes awareness in Africa, with fewer than 50% of
participants in one study aware of their condition.
29
No data were
found for awareness of total cholesterol levels.
The lack of primary healthcare facilities in this region, especially
in rural areas, makes the low levels of previous measurements
plausible. Furthermore, the current training of Angolan health
professionals and the availability of clinical equipment are still
focused on infectious diseases, not considering CVD a priority.
Therefore initiatives promoting the awareness of CVD are lacking
in the region, and proper monitoring of patients’ conditions does
not occur.
Moreover, the information available to the population is not
enough to convince patients to take lifelong medication in order to
treat a condition, which is usually asymptomatic. Only one-third of
participants with any of these conditions had access to treatment,
which demonstrates the inadequacy of the region’s health system
to help patients manage risk factors. Economic difficulties and the
lack of drugs to address CVD may also help explain the low levels
of treatment and control found.
Nevertheless, a positive note should be made as to the number
of patients who had controlled levels of blood pressure, blood
sugar and cholesterolaemia in this specific population.
Considering that they were younger and better educated, they
could have had easier access to drugs and health facilities. Also
noteworthy, in the absence of access to drugs, physicians’ advice in
most cases is to adopt non-pharmacological approaches to reducing
modifiable risk factors, mainly associated with diet.
Strengths and limitations of the study
Our study findings should be interpreted cautiously because the
Dande-HDSS was developed as a district-level surveillance system
in an urban and rural setting and is therefore not representative
of the demographic structure of the country. In addition, age
groups over 65 years old (known for higher rates of the conditions
studied) were not considered owing to their low representation in
the general structure of the population (3.6% of the Dande-HDSS
population),
18
which is a common practice for surveys conducted in
sub-Saharan Africa.
Internal migration and the geographical isolation of some
hamlets within the Dande-HDSS, together with the fact that
working individuals were unavailable during the daytime,
17
were
reflected in the sampling definition, with a 30% non-participation
rate. The distribution of non-respondents was uneven, with a higher
proportion of younger people and men (data not shown). This may
have caused instability in the estimates in some strata.
Participants were requested not to eat anything eight hours
before participating in the study; however, it was difficult to
measure adherence to this request, which adds uncertainty to the
measures of blood glucose and cholesterol. We used dry chemistry
devices to measure glycaemia and cholesterolaemia, but owing to
high temperatures and humidity during field surveys, data collection
was not possible in some cases, causing a higher number of missing
data than expected.
Due to the many variables covered in the survey and to avoid drop-
out of participants in future rounds, additional questions relating to
awareness, pharmacological treatments and non-pharmacological
Table 8.
Awareness, treatment and control rates of hypercholesterolemia by gender (Caxito, 2016)
Awareness
Treatment
Control
All
Female
Male
All
Female
Male
All
Female
Male
(
n
= 3)
(
n
= 2)
(
n
= 1)
(
n
= 1)
(
n
= 1)
(
n
= 0)
(
n
= 1)
(
n
= 1)
(
n
= 0)
%
%
%
%
%
%
%
% %
Education (years
completed)
None
0
0
0
0
0
0
0
0
0
1–4
33.3
50.0
0
0
0
0
0
0
0
5–9
0
0
0
0
0
0
0
0
0
> 10
66.6
50.0
100.0
100.0
100.0
0
100.0
100.0
0
Age (years)
15–24
0
0
0
0
0
0
0
0
0
25–34
0
0
0
0
0
0
0
0
0
35–44
33.3
50.0
0
100.0
100.0
0
100.0
100.0
0
45–54
66.6
50.0
100.0
0
0
0
0
0
0
55–64
0
0
0
0
0
0
0
0
0
Table 9.
Non-pharmacological advice by health professionals to aware
participants (Caxito, 2016)
Hypercholes-
Hypertension Diabetes terolaemia
(
n
= 209)
(
n
= 24)
(
n
= 3)
Advice
% (95% CI) % (95% CI)* % (95% CI)*
Reduce salt in your diet
78.5 (72.4–83.5)
100.0
100.0
Reduce fat in your diet
61.7 (55.0–68.0)
91.7
66.7
Eat at least five servings
of fruit and/or vegetables
each day
58.4 (51.6–64.8)
70.8
66.7
Reduce or stop alchool
consumption
51.2 (44.5–57.9)
83.3
33.3
Start or do more physical
activity
34.4 (28.3–41.1)
75.0
66.7
Quit using tobacco or
don’t start
31.1 (25.2–37.7)
45.8
0
Maintain a healthy body
weight or lose weight
30.1 (24.3-36.7)
75.0
66.7
*Due to the small sample size, the 95% CI was not determined.