Mortality trends and access to care for cardiovascular diseases in Agincourt, rural South Africa: a mixed-methods analysis of verbal autopsy data

ObjectivesCardiovascular diseases are the second leading cause of mortality behind HIV/AIDS in South Africa. This study investigates cardiovascular disease mortality trends in rural South Africa over 20+ years and the associated barriers to accessing care, using verbal autopsy data.DesignA mixed-methods approach was used, combining descriptive analysis of mortality rates over time, by condition, sex and age group, quantitative analysis of circumstances of mortality (CoM) indicators and free text narratives of the final illness, and qualitative analysis of free texts.SettingThis study was done using verbal autopsy data from the Health and Socio-Demographic Surveillance System site in Agincourt, rural South Africa.ParticipantsDeaths attributable to cardiovascular diseases (acute cardiac disease, stroke, renal failure and other unspecified cardiac disease) from 1993 to 2015 were extracted from verbal autopsy data.ResultsBetween 1993 and 2015, of 15 305 registered deaths over 1 851 449 person-years of follow-up, 1434 (9.4%) were attributable to cardiovascular disease, corresponding to a crude mortality rate of 0.77 per 1000 person-years. Cardiovascular disease mortality rate increased from 0.34 to 1.12 between 1993 and 2015. Stroke was the dominant cause of death, responsible for 41.0% (588/1434) of all cardiovascular deaths across all years. Cardiovascular disease mortality rate was significantly higher in women and increased with age. The main delays in access to care during the final illness were in seeking and receiving care. Qualitative free-text analysis highlighted delays not captured in the CoM, principally communication between the clinician and patient or family. Half of cases initially sought care outside a hospital setting (50.9%, 199/391).ConclusionsThe temporal increase in deaths due to cardiovascular disease highlights the need for greater prevention and management strategies for these conditions, particularly for the women. Strategies to improve seeking and receiving care during the final illness are needed.

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Abstract WP205: Long-chain n-3 Polyunsaturated Fatty Acids Intake and Cardiovascular Disease Mortality Risk in a General Japanese Population: NIPPON DATA80

Stroke ◽

10.1161/str.44.suppl_1.awp205 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Naoko Miyagawa ◽

Katsuyuki Miura ◽

Nagako Okuda ◽

Takashi Kadowaki ◽

Naoyuki Takashima ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Diseases ◽

Daily Intake ◽

Community Dwelling ◽

Dietary Sodium ◽

Inverse Association ◽

Cardiovascular Disease Mortality ◽

Disease Mortality ◽

Fish And Shellfish ◽

Long Chain

BACKGROUND: In Western populations, long-chain n-3 polyunsaturated fatty acid (LCn3FAs) intake was shown to be inversely associated with the risk of cardiovascular diseases, particularly that of cardiac disease. Dietary intake of LCn3FAs among Japanese is generally higher than those of Western populations due to their higher intake of fish and shellfish. However, little is known regarding whether an inverse association exists in a population with higher LCn3FAs intake. Furthermore, evidence for association with stroke risk has been limited. OBJECTIVES: To investigate the association between LCn3FAs intake and the risk of cardiovascular diseases and stroke in a Japanese general population. METHODS: We followed-up a total of 9,190 community-dwelling individuals (56.1% women, mean age of 50.0 years) randomly selected from 300 areas across Japan and free from cardiovascular diseases at baseline. Dietary LCn3FAs intake was estimated using household weighed food records. Cox models were used to calculate multivariable adjusted hazard ratios (HRs) and 95% confidence interval (95%CI) according to sex specific quartiles of LCn3FAs intake. HRs were adjusted for age, sex, cardiovascular risk factors, dietary sodium and other nutritional factors. RESULTS: During 24 years of follow-up, 879 cardiovascular deaths were observed. The median daily intake of LCn3FAs was 0.37%kcal. Median value of the lowest quartile of LCn3FAs intake (0.18%kcal) in the present study was twice as high as the average intake in U.S. population. Adjusted HR for cardiovascular disease mortality was lower in the highest quartile of LCn3FAs intake (HR 0.80; 95%CI, 0.66-0.96) compared with the lowest quartile, and the trend was significant ( P =0.038). The similar but statistically non- significant trends were observed for cardiac death and stroke death. CONCLUSIONS: In a representative sample of Japanese with high LCn3FAs intake, the risk of total cardiovascular disease mortality was inversely and independently associated with LCn3FAs intake, and the risk of stroke also showed similar tendency.

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Echocardiographic and Electrocardiographic Abnormalities Among Elderly Adults With Cardiovascular Disease in Rural South Africa

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.121.007847 ◽

2021 ◽

Vol 14 (11) ◽

Author(s):

Enrico G. Ferro ◽

Shafika Abrahams-Gessel ◽

Thiago Veiga Jardim ◽

Ryan Wagner ◽

F. Xavier Gomez-Olive ◽

...

Keyword(s):

South Africa ◽

Cardiovascular Diseases ◽

Left Ventricular Mass ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Organ Damage ◽

Left Ventricular ◽

Rural South ◽

Ventricular Mass ◽

Rural South Africa

Background: Sub-Saharan Africa is undergoing an epidemiological transition fueled by the interaction between infectious and cardiovascular diseases. Our cross-sectional study aimed to characterize the spectrum of abnormalities suggesting end-organ damage on ECG and transthoracic echocardiograms (TTE) among older adults with cardiovascular diseases in rural South Africa. Methods: The prevalence of ECG and TTE abnormalities was estimated; χ 2 analyses and multivariable logistic regressions were performed to test their association with sex, hypertension, and other selected comorbidities. Results: Overall, 729 ECGs and 155 TTEs were completed, with 74 participants completing both. ECG evaluation showed high rates of left ventricular hypertrophy (LVH, 36.5%) and T wave abnormalities (13.6%). TTE evaluation showed high rates of concentric LVH (31.6%), with moderate-severe (56.8%) diastolic dysfunction. Participants with hypertension showed more cardiac remodeling on ECG by LVH (45.4% versus 22.1%, P <0.01), and TTE by concentric LVH (42.5% versus 8.2%, P <0.01) and increased left ventricular mass (58.5% versus 20.4%, P <0.0001). In multivariable logistic regression, systolic blood pressure remained significantly associated with LVH on ECG (adjusted odds ratio, 1.03 per mm Hg [95% CI, 1.03–1.04], P <0.0001) and increased left ventricular mass on TTE (adjusted odds ratio, 1.04 per mm Hg [95% CI, 1.01–1.06], P =0.001). Male participants (n=326, 40.2%) were more likely than females (n=484, 59.8%) to show ECG abnormalities like LVH (45% versus 30.8%, P <0.01), whereas females were more likely to show TTE abnormalities like concentric LVH (40.8% versus 13.5%, P <0.01) and increased left ventricular mass (58.4% versus 23.1%, P <0.0001). Similar results were confirmed in multivariable models. Conclusions: Our findings suggest that cardiovascular diseases are widespread in rural South Africa, with a larger burden of hypertensive heart disease than previously appreciated, and define the severity of end-organ damage that is already underway. Local health systems must adapt to face the growing burden of hypertension, as suboptimal rates of hypertension diagnosis and treatment may dramatically increase the heart failure burden.

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Levels and Correlates of Physical Activity in Rural Ingwavuma Community, uMkhanyakude District, KwaZulu-Natal, South Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186739 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6739

Author(s):

Herbert Chikafu ◽

Moses J. Chimbari

Keyword(s):

Physical Activity ◽

South Africa ◽

Cardiovascular Disease ◽

Vulnerable Groups ◽

Health Awareness ◽

Skeletal Health ◽

Rural South ◽

Kwazulu Natal ◽

Sport And Recreation ◽

Rural South Africa

Physical activity, among others, confers cardiovascular, mental, and skeletal health benefits to people of all age-groups and health states. It reduces the risks associated with cardiovascular disease and therefore, could be useful in rural South Africa where cardiovascular disease (CVD) burden is increasing. The objective of this study was to examine levels and correlates of physical activity among adults in the Ingwavuma community in KwaZulu-Natal (KZN). Self-reported data on physical activity from 392 consenting adults (female, n = 265; male, n = 127) was used. We used the one-sample t-test to assess the level of physical activity and a two-level multiple linear regression to investigate the relationship between total physical activity (TPA) and independent predictors. The weekly number of minutes spent on all physical activities by members of the Ingwavuma community was 912.2; standard deviation (SD) (870.5), with males having 37% higher physical activity (1210.6 min, SD = 994.2) than females (769.2, SD = 766.3). Livelihood activities constituted 65% of TPA, and sport and recreation contributed 10%. Participants without formal education (20%), those underweight (27%), and the obese (16%) had low physical activity. Notwithstanding this, in general, the Ingwavuma community significantly exceeded the recommended weekly time on physical activity with a mean difference of 762.1 (675.8–848.6) minutes, t (391) = 17.335, p < 0.001. Gender and age were significant predictors of TPA in level 1 of the multiple regression. Males were significantly more active than females by 455.4 min (β = −0.25, p < 0.001) and participants of at least 60 years were significantly less active than 18–29-year-olds by 276.2 min (β = −0.12, p < 0.05). Gender, marital status, and health awareness were significant predictors in the full model that included education level, employment status, body mass index (BMI), and physical activity related to health awareness as predictors. The high prevalence of insufficient physical activity in some vulnerable groups, notably the elderly and obese, and the general poor participation in sport and recreation activities are worrisome. Hence we recommend health education interventions to increase awareness of and reshape sociocultural constructs that hinder participation in leisure activities. It is important to promote physical activity as a preventive health intervention and complement the pharmacological treatment of CVDs in rural South Africa. Physical activity interventions for all sociodemographic groups have potential economic gains through a reduction in costs related to the treatment of chronic CVD.

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