Tackling cardiovascular disease in AfricaBMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7519.711 (Published 29 September 2005) Cite this as: BMJ 2005;331:711
All rapid responses
Editor—Kadiri hit the nail on the head in his concluding statement
that the African people need education on healthier lifestyle choices,
such as weight reduction, smoking cessation, and greater physical
activity.(1) However, the continent’s people need more than education.
They also need action for effective health promotion and disease
prevention. As Goethe so beautifully put it, “Knowing is not enough; we
must apply”. We have ample evidence of effective individual and
population-based interventions for preventing epidemic cardiovascular
disease. The adverse cardiovascular trends seen in Africa today cannot be
halted without individual, policy, and socio-environmental actions for
change. The capacity for this action must be built from the grassroots up
and will require national, regional, and global assistance. Several
examples of such capacity-building endeavors exist.
In the summer of 2003, the U.S. Centers for Disease Control and
Prevention (CDC), in partnership with the International Society on
Hypertension in Blacks, planned a world congress on cardiovascular health
promotion and the prevention of chronic non-communicable diseases in
Africa.(2) The world congress itself was canceled because of the
lingering aftermath of the September 11 terrorist event, but a collection
of plenary papers was published and remains an enduring testament to the
collective will of international health organizations to spur action for
change . The special journal supplement highlighted the role of policy
development, environmental change, system redesign, and program-relevant
Later that year, the CDC, in cooperation with the International Union
for Health Promotion and Education, convened 30 clinical and public health
experts from 15 countries (most of them from sub-Saharan Africa) in Accra,
Ghana, to provide recommendations for the design, operation, and
evaluation of an annual 10-day seminar on cardiovascular health promotion
and chronic disease prevention to be offered in sub-Saharan Africa. The
purpose of the annual seminar is to help build capacity to prevent and
control heart disease and stroke while fostering a better understanding of
the increasing burden of chronic diseases and risk factors in sub-Saharan
Africa. Coincidentally, the second annual seminar is currently in
progress in Accra this week.
The challenges of underfunding, poor infrastructure, inadequate
access to inexpensive medications, and the lack of recognition of the
importance of cardiovascular and other chronic non-communicable diseases
pointed out by Kadiri are real. In addition, we cannot overlook the
enormous challenges that face an ill-equipped public health workforce in
sub-Saharan Africa, which is already overburdened with the unfinished
agenda of infectious disease control.(4) Nor can we ignore the serious
lack of capacity for appropriate local and continuing education in the
region. Nevertheless, tackling cardiovascular disease in Africa cannot be
postponed but must be addressed now. Strategies for improving North-South
and South-South interactions will help build capacity for program-relevant
research and will strengthen institutions.(3-8) We must seize this
opportunity to work collaboratively with colleagues and experts from
Africa to improve cardiovascular health for all. The BMJ, in its recent
theme issue, deserves great credit for highlighting cardiovascular
diseases in Africa without downplaying the ongoing importance of
communicable diseases and maternal and child health.
George A. Mensah, MD,
Distinguished Scientist, National Center for Chronic Disease Prevention
and Health Promotion, CDC, Atlanta, Georgia 30341
CONFLICTS OF INTEREST: None
The findings and conclusions in this letter are those of the author
and do not necessarily represent the views of the CDC.
1. Kadiri S. Tackling cardiovascular disease in Africa. BMJ.
2. Mensah GA. A world congress on cardiovascular health in sub-
Saharan Africa: Much ado about something! Ethn Dis 2003;13(2 Suppl 2): S2-
3. Mensah GA. A heart-healthy and "stroke-free" world through policy
development, systems change, and environmental supports: a 2020 vision for
sub-Saharan Africa. Ethn Dis 2003;13(2 Suppl 2): S4-12.
4. Beaglehole R, Sanders D, Dal PM. The public health workforce in
sub-Saharan Africa: challenges and opportunities. Ethn Dis 2003;13(2 Suppl
5. Armstrong T, Bonita R. Capacity building for an integrated
noncommunicable disease risk factor surveillance system in developing
countries. Ethn Dis 2003;13(2 Suppl 2): S13-S18.
6. Mittelmark MB. The role of professional education in building
capacity for health promotion in the global South: a case study from
Norway. Ethn Dis 2003;13(2 Suppl 2): S35-S39.
7. Nchinda TC. Research capacity development for CVD prevention: the
role of partnerships. Ethn Dis 2003;13(2 Suppl 2): S40-S44.
8. Wilson EE. The role of the World Heart Federation in
cardiovascular health promotion and disease prevention in developing
countries with a special emphasis on sub-Saharan Africa. Ethn Dis 2003;
13(2 Suppl 2):S164-S166.
Competing interests: No competing interests
I read the editorial, I have some opinion regarding the impact of cardiovascular diseases in developing world. Deaths due to infectious diseases cause acute mortality on a mass scale that's why they get greater attention, whereas heart disease causes mortality throughout the year and at the same time most of the deaths attributed to an infectious etiology are actually due to cardiac disease, and infection may be the precipitating factor. At the same time most of the data in these countries comes from hospitals, and because infectious diseases mostly present with acute clinical signs and symptom they get the clinical attention early. Hypertension and hyperlipidemia like conditions are mostly recognised only after the development of complications, and this may be the reason for underrepresentaton of heart diseases in developing world. Here it is also important to highlight that the proportion of deaths due to heart disease may be less than infectious diseases, but overall mortality due to heart disease is more in developing countries in comparison to developed world due to less infrastrucure and less attention as well.
Dr ALOK KUMAR SINGH M.D
SENIOR RESIDENT DEPARMENT OF CARDIOLOGY,
INSTITUTE OF MEDICAL SCIENCES,
B.H.U VARANASI, 221005 INDIA
Competing interests: No competing interests