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Schwartz JI, Guwatudde D, Nugent R, Kiiza CM. Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data. Global Health 2014; 10:77. [PMID: 25406738 PMCID: PMC4240853 DOI: 10.1186/s12992-014-0077-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/24/2014] [Indexed: 11/25/2022] Open
Abstract
The demographic and nutritional transitions taking place in Uganda, just as in other low- and middle-income countries (LMIC), are leading to accelerating growth of chronic, non-communicable diseases (NCDs). Though still sparse, locally derived data on NCDs in Uganda has increased greatly over the past five years and will soon be bolstered by the first nationally representative data set on NCDs. Using these available local data, we describe the landscape of the globally recognized major NCDs- cardiovascular disease, diabetes, cancer, and chronic respiratory disease- and closely examine what is known about other locally important chronic conditions. For example, mental health disorders, spawned by an extended civil war, and highly prevalent NCD risk factors such as excessive alcohol intake and road traffic accidents, warrant special attention in Uganda. Additionally, we explore public sector capacity to tackle NCDs, including Ministry of Health NCD financing and health facility and healthcare worker preparedness. Finally, we describe a number of promising initiatives that are addressing the Ugandan NCD epidemic. These include multi-sector partnerships focused on capacity building and health systems strengthening; a model civil society collaboration leading a regional coalition; and a novel alliance of parliamentarians lobbying for NCD policy. Lessons learned from the ongoing Ugandan experience will inform other LMIC, especially in sub-Saharan Africa, as they restructure their health systems to address the growing NCD epidemic.
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Affiliation(s)
- Jeremy I Schwartz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Young Professionals Chronic Disease Network, Boston, MA, USA.
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda.
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
| | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Charles Mondo Kiiza
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda.
- Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda.
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Bonny A, Ngantcha M, Amougou SN, Kane A, Marrakchi S, Okello E, Taty G, Gehani A, Diakite M, Talle MA, Lambiase PD, Houenassi M, Chin A, Otieno H, Temu G, Owusu IK, Karaye KM, Awad AAM, Winkel BG, Priori SG. Rationale and design of the Pan-African Sudden Cardiac Death survey: the Pan-African SCD study. Cardiovasc J Afr 2014; 25:176-84. [PMID: 25192301 PMCID: PMC4170179 DOI: 10.5830/cvja-2014-035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300,000 to 400,000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. METHODS The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. CONCLUSION This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.
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Affiliation(s)
- Aimé Bonny
- Teaching Hospital Laquintinie, University of Douala, Douala, Cameroon; Service de Cardiologie, Centre Hospitalier Victor Provo, Roubaix, France.
| | | | - Sylvie Ndongo Amougou
- Service de Réanimation Médicale, Centre Hospitalier, Universitaire de Yaoundé, Cameroon
| | - Adama Kane
- Service de Cardiologie, Centre Hospitalier le Dantec, Dakar, Senegal
| | - Sonia Marrakchi
- Service de Cardiologie, Hopital Abderrrahmen Mami Ariana, Tunis, Tunisia
| | - Emmy Okello
- Department of Internal Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Georges Taty
- Service de Médecine Interne, Centre Hospitalier Général de Port-Gentil, Gabon
| | | | | | - Mohammed A Talle
- Department of Internal Medicine, University of Maiduguri Teaching Hospital, Nigeria
| | - Pier D Lambiase
- Institute of Cardiovascular Sciences, University College London, UK
| | - Martin Houenassi
- Service de Cardiologie, Centre Hospitalier Universitaire Abomey Calavi de Cotonou, Benin
| | - Ashley Chin
- Department of Cardiology, UCT Private Academic Hospital, Cape Town, South Africa
| | - Harun Otieno
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Gloria Temu
- Department of Cardiology, Kilimanjaro Christian Medical Centre, Tanzania
| | - Isaac Koffi Owusu
- Department of Cardiology, University Teaching Hospital of Accra, Ghana
| | - Kamilu M Karaye
- Department of Cardiology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abdalla A M Awad
- Department of Cardiology, University Hospital of Khartoum, Sudan
| | | | - Silvia G Priori
- Department of Molecular Genetics, Fondazione Salvatore Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy
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Ntsekhe M, Damasceno A. Recent advances in the epidemiology, outcome, and prevention of myocardial infarction and stroke in sub-Saharan Africa. Heart 2013; 99:1230-5. [PMID: 23680888 DOI: 10.1136/heartjnl-2012-303585] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The early part of the new millennium witnessed reports of a growing burden of cardiovascular disease in Sub-Saharan Africa (SSA). However the contribution of ischemic heart disease and stroke to this increasing burden relative to that caused by hypertensive heart disease, cardiomyopathy and rheumatic heart disease was not clear. Over the last decade, data from the continent has begun to clarify this issue and suggests three main points. The burden of ischemic heart disease relative to other causes of heart disease remains low particularly in the black Africans majority. Stroke caused predominantly by hypertension is now a major cause of disability and premature death. Third, the burden of risk factors for atherosclerosis is increasing rapidly in most urban and some rural regions. A concerted effort to understand the primary drivers of this increase in cardiac risk factors is required to prevent a future epidemic of atherosclerosis and its sequelae.
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Affiliation(s)
- Mpiko Ntsekhe
- Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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