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European Journal of Applied Sciences – Vol. 10, No. 2
Publication Date: April 25, 2022
DOI:10.14738/aivp.102.11899. Rweyemamu, S. J., Waane, T., Longopa, G. L., Kisenge, P. R., Bishashara, S., Mpella, R., & Mutagaywa, R. (2022). Prevalence of
Cardiovascular Diseases and Associated Factors Among Patients in Low- and Middle-Income Settings. European Journal of Applied
Sciences, 10(2). 362-379.
Services for Science and Education – United Kingdom
Prevalence of Cardiovascular Diseases and Associated Factors
Among Patients in Low- and Middle-Income Settings
Samwel Jacob Rweyemamu
Jakaya Kikwete Cardiac Institute, P. O. Box 65141
Dar es Salaam, Tanzania
Tatizo Waane
Jakaya Kikwete Cardiac Institute, P. O. Box 65141
Dar es Salaam, Tanzania
George L. Longopa
Jakaya Kikwete Cardiac Institute, P. O. Box 65141
Dar es Salaam, Tanzania
Peter Richard Kisenge
Jakaya Kikwete Cardiac Institute, P. O. Box 65141
Dar es Salaam, Tanzania
Sophia Bishashara
Jakaya Kikwete Cardiac Institute, P. O. Box 65141
Dar es Salaam, Tanzania
Rosemary Mpella
Jakaya Kikwete Cardiac Institute, P. O. Box 65141
Dar es Salaam, Tanzania
Reuben Mutagaywa
School of Medicine, Muhimbili University of Health and
Allied Sciences, P.O. BOX 65001, Tanzania
ABSTRACT
Background: Cardiovascular Diseases (CVDs) are the public health problems
worldwide, causing over 18.9 million deaths per year. The major risk factors which
are also preventable are tobacco use, diabetes, high blood pressure, overweight/
obesity and alcohol consumption. The aim of this study was to determine the
Prevalence of CVDs and associated factors. Methodology: We conducted a cross- sectional hospital-based study that consecutively enrolled 785 consenting adults
who came to attend Jakaya Kikwete Cardiac Institute (JKCI) mobile clinic in South
Western urban Tanzania, a typical LMIC, in 2018. A structured questionnaire was
used to obtain demographic data and gather several co-morbid information. A 12
lead Electrocardiogram (ECG) and 2D, M mode Transthoracic Echocardiogram were
done to determine the structural and none structural heart diseases from the
participants. Results: Of 785 participants, 528 (67.3 %) were females, 479 (61%)
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363
Rweyemamu, S. J., Waane, T., Longopa, G. L., Kisenge, P. R., Bishashara, S., Mpella, R., & Mutagaywa, R. (2022). Prevalence of Cardiovascular
Diseases and Associated Factors Among Patients in Low- and Middle-Income Settings. European Journal of Applied Sciences, 10(2). 362-379.
URL: http://dx.doi.org/10.14738/aivp.102.11899
were middle aged (40-60 years) and 196 (25%) were 65 years old and above, their
mean age (±SD) was 56 (±14) years. Most of participants were married 558 (71%),
625 (80%) sponsored by the National Health Insurance Fund (NHIF) and less than
half were employed. Of all the participants, tobacco users were 29(3.6%), diabetics
60 (7.5%), alcoholic users 99 (12.5%) and more than half were overweight/obese.
The prevalence of Systolic Hypertension was 65% and Diastolic Hypertension was
50% Few participants 85 (11%) had chest pain, 56 (7%) had tachycardia and
difficulty in breathing 45 (6%). By ECHO diagnosis; the prevalence of dilated
cardiomyopathy was 3.8%, hypertensive heart diseases 2.3% and valvular heart
diseases was 2%. Majority 780 (99%) and 694 (88%) had normal Left Ventricular
Systolic and Diastolic functions respectively. Furthermore, by ECG diagnosis, the
prevalence of Left Ventricular Hypertrophy was 8% and ischemic heart disease was
diagnosed in 4% of the participants. In a multivariate analysis, CVD were found to
be statistically significant associated with the age 65+ years, 3.41 [95% CI 1.49 -
7.78, p- value 0.004], diastolic blood pressure above or equal to 90 mmHg, 1.61
[95% CI 1.05 -2.48, p -value 0.03] and overweight/ obese 1.94 [95% CI 1.28 -2.92, p- value 0.002]. Conclusion: The prevalence of cardiovascular diseases was found to
be high and the main associated risk factors were advanced age, overweight/obese
and diastolic hypertension. Some of the participants had already developed
asymptomatic structural heart disease and features which were suggesting of
coronary artery diseases.
BACKGROUND
Cardiovascular disease (CVD) is the group of diseases which includes structural heart diseases,
coronary artery disease and all diseases of the blood vessels in the brain and other peripheral
circulatory systems of the human. In 2016, World Health Organization (WHO) reported that
CVD kills more than 17.9 million people annually all over the continents, representing 31% of
all deaths(1). Low and middle income countries are more affected and about 80% of all death
are due to acute/chronic coronary syndromes and cerebrovascular events such as stroke (2–
5). Young and middle aged individuals die of CVD and therefore WHO and World Heart
Federation (WHF) are working together to reducer these mortalities by 25% by 2025/30 in all
countries (5,6).
The risk factor for cardiovascular diseases such as diabetes and overweight/obesity begins
early in childhood and adolescents The earlier manifestations of these risk factors predicts the
earlier increase of asymptomatic CVDs younger adults (7,8). The children /adolescents remains
asymptomatic but the evidence from the autopsy and land marks trial showed the existence of
subclinical conditions at the age of 22 years old (9). Among those who died at an age of 18 years
without diabetes mellitus, autopsy studies found a close relationship of aortic fatty streaks with
an increased level of total cholesterol and low-density lipoprotein cholesterol (LDL-c)(10).
Coronary artery diseases begin early in childhood/adolescents and the individual remains
subclinical. One study which involved 2,876 participants aged between 15 and 34 years old
found atherosclerotic lesions in coronary arteries (11). The main pathology of CVD is the
asymptomatic gradual onset of atherosclerosis which begins early in life time. The symptoms
and complications are overt as an individual becomes older (12,13).
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European Journal of Applied Sciences (EJAS) Vol. 10, Issue 2, April-2022
Services for Science and Education – United Kingdom
In United State of America (USA) CVDS is the leading cause of morbidity and mortality and
about 40 million individuals over the age of 65 are affected (14,15). Morbidity and Mortality
rates increases with age, for instance individuals with age of 80 years the prevalence is above
80% (15).
In the Sub-Saharan Africa countries where majority of the people lives in rural areas the trends
of risk factors for cardiovascular diseases are increasing, however with variations among
countries.
In Mozambique, about 64% of the population lives in rural areas. In this country, the prevalence
of adults with obese (BMI of ≥30 kg/m2) is 9.7% which is less than that reported globally
(13.1%) (16). The prevalence of Rheumatic Heart Diseases (RHD) is 3.04% which is also higher
than that which was reported globally (0.53%) and the mortality rates attributable by RHD is
0.16%(16). Furthermore, the rates of tobacco use among adults is 23% males , 3% females ,
hypertension 31%, diabetes 7.4% (16). In this low income country, cardiovascular mortality
rate is about 11.62% (16).
The aim of this study was to determine Prevalence of Cardiovascular Diseases and associated
factors among patients who came to attend JKCI mobile clinic in South Western urban Tanzania.
Also, the study aimed at creating the database for the risk factors of CVDs in South West urban
settings. The results of this study will help the policymakers to propagate the current
preventive measures for CVDs.
METHODOLOGY
Study design
A cross-sectional community-based study
Study population
785 consenting adults were consecutively recruited, who came to attend JKCI mobile Clinic at
Songea Regional Referral Hospital in South West urban Tanzania in 2018.
Study tools
12 lead Electrocardiogram and a 2D, M mode Transthoracic Echocardiogram were used to
determine the structural and none structural heart changes from the participants. A structured
questionnaire was used to obtain and gather comorbid information such as record blood
pressure, Body weight/BMI and fasting / random blood sugar. BP was checked while the
patient was sitting on the chair with their feet kept flat on the floor a. Three readings were
obtained at the interval of three minutes when the first was high for those who were not
previously diagnosed with hypertension. The average of the last two reading was calculated to
determine the final diagnosis of hypertension. The statistical analysis was done using IBM SPSS
Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp, U.S.A
Ethical Consideration
The ethical clearance was obtained from Jakaya Kikwete Cardiac Institute Review Board and
from the management of Songea Regional Referral Hospital. A comprehensive informed
consent form was signed by the participant or a close relative of a participant. The issue of