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Li C, Spencer G, Husain MJ, Nugent R, Auzenne D, Kostova D, Richter P. Barriers to accessibility of medicines for hyperlipidemia in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002905. [PMID: 38346061 PMCID: PMC10861044 DOI: 10.1371/journal.pgph.0002905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
Despite the high burden of hyperlipidemia and the effectiveness of treatment, evidence suggests that the accessibility of hyperlipidemia medicines can be low in many low- and middle-income countries (LMICs). The aim of this study was to identify common barriers to the accessibility of medicines for hyperlipidemia in LMICs. A multimethod analysis and multiple data sources were used to assess the accessibility and barriers of medicines for hyperlipidemia in selected LMICs. The overall median availability of statins for hyperlipidemia in public facilities was 0% and 5.4%, for originators and generics, respectively. In private facilities, median availability was 13.3% and 35.9%, for originators and generics, respectively. Statin availability was lowest in Africa and South-East Asia. Private facilities generally had higher availability than public facilities. Statins are less affordable in lower-income countries, costing around 6 days' wages per month. Originator statins are less affordable than generics in countries of all income-levels. The median cost for statin medications per month ranges from a low of $1 in Kenya to a high of $62 in Mexico, with most countries having a median monthly cost between $3.6 and $17.0. The key informant interviews suggested that accessibility to hyperlipidemia medicines in LMICs faces barriers in multiple dimensions of health systems. The availability and affordability of statins are generally low in LMICs. Several steps could be implemented to improve the accessibility of hyperlipidemia medicines, including private sector engagement, physician education, investment in technology, and enhancement of health systems.
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Affiliation(s)
- Chaoyang Li
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Muhammad Jami Husain
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Deon Auzenne
- Department of Psychology, Howard University, Washington, District of Columbia, United States of America
| | - Deliana Kostova
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patricia Richter
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Harrison MA, Marfo AFA, Annan A, Ankrah DNA. Access to cardiovascular medicines in low- and middle-income countries: a mini review. Glob Health Res Policy 2023; 8:17. [PMID: 37221559 DOI: 10.1186/s41256-023-00301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Many cardiovascular (CV) medicines are required for long term. However, with their limited resources, low- and middle-income countries (LMICs) may have challenges with access to cardiovascular medicines. The aim of this review was to provide a summary of available evidence on access to cardiovascular medicines in LMICs. METHODS We searched PubMed and Google scholar for English language articles on access to cardiovascular medicines for the period 2010-2022. We also searched for articles reporting measures for challenges in access to CV medicines from 2007 to 2022. Studies conducted in LMICs, and reporting availability and affordability were included for review. We also reviewed studies reporting affordability or availability using the World Health Organisation/Health Action International (WHO/HAI) method. Levels of affordability and availability were compared. RESULTS Eleven articles met the inclusion criteria for review on availability and affordability. Although availability appears to have improved, many countries did not meet the availability target of 80%. Between economies and within countries, there are equity gaps in access to CV medicines. Availability is lower in public health facilities than private facilities. Seven out of 11 studies reported availability less than 80%. Eight studies which investigated availability in the public sector reported less than 80% availability. Overall, CV medicines, especially combined treatments are not affordable in the majority of countries. Simultaneous achievement of availability and affordability target is low. In the studies reviewed, less than 1-53.5 days wages were required to purchase one month supply of CV medicines. Failure to meet affordability was 9-75%. Five studies showed that, on average 1.6 days' wages of the Lowest-Paid Government Worker (LPGW) was required to purchase generic CV medicines in the public sector. Efficient forecasting and procurement, increased public financing and policies to improve generic use, among others are measures for improving availability and affordability. CONCLUSIONS Significant gaps exist in access to cardiovascular medicines in LMICs, and in many low-and lower middle-income countries access to cardiovascular medicines is low. To improve access and achieve the Global Action Plan on non-communicable diseases in these countries, policy interventions must be urgently instituted.
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Affiliation(s)
- Mark Amankwa Harrison
- Pharmacy Department, Korle Bu Teaching Hospital, Korle Bu, P.O. Box 77, Accra, Ghana.
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustine Annan
- Pharmacy Department, Korle Bu Teaching Hospital, Korle Bu, P.O. Box 77, Accra, Ghana
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Naicker I, Suleman F, Perumal-Pillay VA. A quantitative comparison of essential cardiovascular medicines from countries in the Southern African Development Community to the WHO model essential medicines list. J Pharm Policy Pract 2022; 15:97. [PMID: 36482421 PMCID: PMC9733348 DOI: 10.1186/s40545-022-00494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, cardiovascular disease (CVD) is a leading cause of death and disproportionately affects low- and middle-income countries (LMICs). The WHO Model List of Essential Medicines (WHO EML) is a tool for improving accessibility and availability of medicines. This study compared the 2021 WHO EML CVDs basket of medicines with latest available national essential medicines list (NEMLs) for South Africa and 15 Southern African Development Community (SADC) countries to assess consistency in CVDs medicine listing. METHODS This descriptive, desktop review study compared SADC NEMLs. A comparator list was extracted by combining cardiovascular medicines listed in the 2021 WHO EML for adults and children. SADC country NEMLs were obtained from the WHO Essential Medicines and Health Products Information Portal. Consistency of NEMLs was calculated as a percentage coverage of CVD medicines listed in the 2021 WHO EML. SA hospital and primary health care (PHC) level NEMLs were included as separate formularies. RESULTS The SA hospital level NEML scored 70% consistency with the 2021 WHO EML. Tanzania (84%), Namibia (81%) and Angola (79%) scored the highest consistency. The mean consistency for SADC NEMLs was 66%. The lowest scoring country was Eswatini at 26%. The SA PHC NEML scored 35%. The least listed medicines were beta-blockers, angiotensin receptor blockers (ARBs), clopidogrel (43%) and paediatric formulations (furosemide (21%); digoxin (43%)). Individual antihypertensive medicines were most commonly listed. Botswana and Lesotho were the only countries to list a single pill combination (SPC) for the treatment of hypertension. CONCLUSIONS This comparison indicates that South Africa and most SADC countries are aligned with 2021 WHO EML recommendations. The inclusion of age-appropriate formulations for children as well as ARBs and SPC for the treatment of hypertension may improve patient adherence and cardiovascular outcomes in these countries. More frequent updates to NEMLs should improve consistency. NEMLs were not available for two countries, and these therefore did not form part of this study. Country health expenditure in ranking the consistency of NEMLs was not accounted for. LMICs adopting the essential medicine list strategy should consider imposing minimum consistency thresholds to the WHO EML to improve accessibility and availability of CVD medicines. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ian Naicker
- grid.16463.360000 0001 0723 4123Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000 South Africa
| | - Fatima Suleman
- grid.16463.360000 0001 0723 4123College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Velisha Ann Perumal-Pillay
- grid.16463.360000 0001 0723 4123Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000 South Africa
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Saluja K, Reddy KS, Wang Q, Zhu Y, Li Y, Chu X, Li R, Hou L, Horsley T, Carden F, Bartolomeos K, Hatcher Roberts J. Improving WHO's understanding of WHO guideline uptake and use in Member States: a scoping review. Health Res Policy Syst 2022; 20:98. [PMID: 36071468 PMCID: PMC9449928 DOI: 10.1186/s12961-022-00899-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/16/2022] [Indexed: 11/20/2022] Open
Abstract
Background WHO publishes public health and clinical guidelines to guide Member States in achieving better health outcomes. Furthermore, WHO’s Thirteenth General Programme of Work for 2019–2023 prioritizes strengthening its normative functional role and uptake of normative and standard-setting products, including guidelines at the country level. Therefore, understanding WHO guideline uptake by the Member States, particularly the low- and middle-income countries (LMICs), is of utmost importance for the organization and scholarship. Methods We conducted a scoping review using a comprehensive search strategy to include published literature in English between 2007 and 2020. The review was conducted between May and June 2021. We searched five electronic databases including CINAHL, the Cochrane Library, PubMed, Embase and Scopus. We also searched Google Scholar as a supplementary source. The review adhered to the PRISMA-ScR (PRISMA extension for scoping reviews) guidelines for reporting the searches, screening and identification of evaluation studies from the literature. A narrative synthesis of the evidence around key barriers and challenges for WHO guideline uptake in LMICs is thematically presented.
Results The scoping review included 48 studies, and the findings were categorized into four themes: (1) lack of national legislation, regulations and policy coherence, (2) inadequate experience, expertise and training of healthcare providers for guideline uptake, (3) funding limitations for guideline uptake and use, and (4) inadequate healthcare infrastructure for guideline compliance. These challenges were situated in the Member States’ health systems. The findings suggest that governance was often weak within the existing health systems amongst most of the LMICs studied, as was the guidance provided by WHO’s guidelines on governance requirements. This challenge was further exacerbated by a lack of accountability and transparency mechanisms for uptake and implementation of guidelines. In addition, the WHO guidelines themselves were either unclear and were technically challenging for some health conditions; however, WHO guidelines were primarily used as a reference by Member States when they developed their national guidelines. Conclusions The challenges identified reflect the national health systems’ (in)ability to allocate, implement and monitor the guidelines. Historically this is beyond the remit of WHO, but Member States could benefit from WHO implementation guidance on requirements and needs for successful uptake and use of WHO guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00899-y.
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Affiliation(s)
- Kiran Saluja
- Bruyere Research Institute, Ottawa, Canada.,Science Division, World Health Organization, Geneva, Switzerland
| | - K Srikanth Reddy
- Bruyere Research Institute, Ottawa, Canada. .,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada. .,Using Evidence Inc., Ottawa, Canada. .,Science Division, World Health Organization, Geneva, Switzerland.
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Ying Zhu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Yanfei Li
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiajing Chu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Rui Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liangying Hou
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | | | | | - Janet Hatcher Roberts
- WHO Collaborating Centre for Knowledge Translation and Health Impact Assessment in Health Equity, Bruyere Research Institute, University of Ottawa, Ottawa, Canada
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Pallikadavath S, Ashton L, Brunskill NJ, Burton JO, Gray LJ, Major RW. Aspirin for the primary prevention of cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis. Eur J Prev Cardiol 2021; 28:1953-1960. [PMID: 34448849 DOI: 10.1093/eurjpc/zwab132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/12/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022]
Abstract
AIMS Cardiovascular disease (CVD) is the major cause of morbidity and mortality in individuals with chronic kidney disease (CKD). This study assessed the risks and benefits of aspirin in the primary prevention of CVD in individuals with CKD. METHODS AND RESULTS Ovid MEDLINE was searched from 2015 to 15th of September 2020 to include randomized controlled trials that assessed aspirin versus placebo in adults with non-end stage CKD without a previous diagnosis of CVD. A pre-specified protocol was registered with PROSPERO (identification number CRD42014008860). A random effects model was used to calculate a pooled hazard ratio (HR), pooled risk difference, and the number needed to treat or harm (NNT/NNH). The primary endpoint was CVD. Secondary endpoints included: all-cause mortality; coronary heart disease; stroke; and major and minor bleeding events. Five trials were identified (n = 7852 total, n = 3935 aspirin, n = 3917 placebo). Overall, 434 CVD events occurred. There was no statistically significant reduction in CVD events (HR 0.76, 95% confidence interval (CI) 0.54-1.08; P = 0.13, I2 = 63%), all-cause mortality (HR 0.94, 95% CI 0.74-1.19; P = 0.60, I2 = 21%), coronary heart disease events (HR 0.66, 95% CI 0.27-1.63; P = 0.37, I2 = 64%) or stroke (HR 0.87, 95% CI 0.6-1.27; P = 0.48, I2 = 24%) from aspirin therapy. The risk of major bleeding events were increased by approximately 50% (HR 1.53, 95% CI 1.13-2.05; P = 0.01, I2 = 0%) and minor bleeding events were more than doubled (HR 2.64, 95% CI 1.64-4.23; P < 0.01, I2 = 0%). CONCLUSIONS Aspirin cannot be routinely recommended for the primary prevention of CVD in individuals with CKD as there is no evidence for its benefit but there is an increased risk of bleeding.
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Affiliation(s)
- Susil Pallikadavath
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre for Cardiovascular Disease, University of Leicester, Glenfield Hospital, Leicester, LE39QP, UK
| | - Leah Ashton
- Leicester Medical School, College of Life Sciences, University of Leicester, Leicester, UK
| | - Nigel J Brunskill
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK.,John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rupert W Major
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK.,Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Dzudie A, Hoover D, Kim HY, Ajeh R, Adedimeji A, Shi Q, Pefura Yone W, Nsame Nforniwe D, Thompson Njie K, Pascal Kengne A, Ebasone PV, Barche B, Bissek Anne Cecile ZK, Nash D, Yotebieng M, Anastos K. Hypertension among people living with HIV/AIDS in Cameroon: A cross-sectional analysis from Central Africa International Epidemiology Databases to Evaluate AIDS. PLoS One 2021; 16:e0253742. [PMID: 34292956 PMCID: PMC8297808 DOI: 10.1371/journal.pone.0253742] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Antiretroviral therapy (ART) success has led people to live longer with HIV/AIDS (PLWH) and thus be exposed to increasing risk of cardiovascular diseases (CVD). Hypertension (HTN), the biggest contributor to CVD burden, is a growing concern among PLWH. The current report describes the prevalence and predictors of HTN among PLWH in care in Cameroon. Methods This cross-sectional study included all PLWH aged 20 years and above who received care between 2016 and 2019 at one of the three Central Africa International Epidemiology Databases to Evaluate AIDS (CA-IeDEA) sites in Cameroon (Bamenda, Limbe, and Yaoundé). HTN was defined as blood pressure (BP) ≥140/90 mm Hg or self-reported use of antihypertensive medication. Logistic regressions models examined the relationship between HTN and clinical characteristics, and HIV-related factors. Results Among 9,839 eligible PLWH, 66.2% were women and 25.0% had prevalent HTN [age-standardized prevalence 23.9% (95% CI: 22.2–25.6)], among whom 28 (1.1%) were on BP lowering treatment, and 6 of those (21.4%) were at target BP levels. Median age (47.4 vs. 40.5 years), self-reported duration of HIV infection (5.1 vs 2.8 years years), duration of ART exposure (4.7 vs 2.3 years), and CD4 count (408 vs 359 cell/mm3) were higher in hypertensives than non-hypertensives (all p<0.001). Age and body mass index (BMI) were independently associated with higher prevalent HTN risk. PLWH starting ART had a 30% lower risk of prevalent HTN, but this advantage disappeared after a cumulative 2-year exposure to ART. There was no significant association between other HIV predictive characteristics and HTN. Conclusion About a quarter of these Cameroonian PLWH had HTN, driven among others by age and adiposity. Appropriate integration of HIV and NCDs services is needed to improve early detection, treatment and control of common comorbid NCD risk factors like hypertension and safeguard cardiovascular health in PLWH.
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Affiliation(s)
- Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Service of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Department of Global Health and Population, Lown Scholars Program, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Donald Hoover
- Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers the State University of New Jersey, New Brunswick, New Jersey, United States of America
| | - Hae-Young Kim
- Department of Public Health, New York Medical College, Valhalla, New York, United States of America
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaounde, Cameroon
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States of America
| | - Qiuhu Shi
- Department of Public Health, New York Medical College, Valhalla, New York, United States of America
| | - Walter Pefura Yone
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Jamot Hospital, Yaounde, Cameroon
| | | | | | - Andre Pascal Kengne
- Clinical Research Education, Networking and Consultancy, Yaounde, Cameroon
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, South Africa
| | | | - Blaise Barche
- Clinical Research Education, Networking and Consultancy, Yaounde, Cameroon
| | - Zoung-Kany Bissek Anne Cecile
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Division of Operational Health Research (DROS), Ministry of Public Health (MSP), Yaounde, Cameroon
| | - Denis Nash
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, United States of America
- Department of Epidemiology and Biostatistics, Graduate School of Public Health, City University of New York, New York, New York, United States of America
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States of America
| | - Kathryn Anastos
- Department of Public Health, New York Medical College, Valhalla, New York, United States of America
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States of America
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Mouton JP, Blockman M, Sekaggya-Wiltshire C, Semakula J, Waitt C, Pirmohamed M, Cohen K. Improving anticoagulation in sub-Saharan Africa: What are the challenges and how can we overcome them? Br J Clin Pharmacol 2021; 87:3056-3068. [PMID: 33586223 PMCID: PMC8359270 DOI: 10.1111/bcp.14768] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/04/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Patients in sub-Saharan Africa generally have poor anticoagulation control. We review the potential reasons for this poor control, as well as the potential solutions. Challenges include the affordability and centralisation of anticoagulation care, problems with access to medicines and international normalised ratio monitoring, the lack of locally validated standardized dosing protocols, and low levels of anticoagulation knowledge among healthcare workers and patients. Increasing numbers of patients will need anticoagulation in the future because of the increasing burden of noncommunicable disease in the region. We propose that locally developed "warfarin care bundles" which address multiple anticoagulation challenges in combination may be the most appropriate solution in this setting currently.
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Affiliation(s)
- Johannes P Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marc Blockman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Jerome Semakula
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catriona Waitt
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Karen Cohen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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Peer N, Baatiema L, Kengne AP. Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future. Expert Rev Cardiovasc Ther 2020; 19:129-140. [PMID: 33305637 DOI: 10.1080/14779072.2021.1855975] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Although cardiovascular diseases (CVDs) are among the leading causes of death in Sub-Saharan Africa (SSA), prevention is not a priority and effective treatments are not widely available. This perspective discusses the burden, challenges, and potential opportunities for improvement of CVD prevention and control efforts in SSA. AREAS COVERED This paper focuses on ischemic heart disease and stroke, and their key contributors of obesity, hypertension, diabetes and dyslipidaemia which are well-established, rapidly rising, and significant contributors to disease burden in SSA. However, their prevention, detection, treatment and control of are currently disorganized, inconsistent, unreliable, and insufficient with most SSA countries not geared to respond to this growing problem. National policies are frequently lacking or, if available, remain poorly implemented, for the control of these conditions. Primary healthcare systems have not adapted to cope with these rising CVD burdens and remain weak, underfunded and under resourced. Numerous barriers at the healthcare service, healthcare provider, and patient levels prevent optimal CVD risk factor care. EXPERT OPINION Innovative approaches such as task-shifting with the reallocation of care to lower-level healthcare workers and the potential use of inexpensive technological options should be encouraged to provide equitable CVD preventive and curative solutions to SSA's poor.
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Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Leonard Baatiema
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Andre-Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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