Reducing burden of heart disease in Nigeria
By Stanley Akpunonu
Today is World Heart Day (WHD). World Heart Federation (WHF) has set aside September 29 of every year to celebrate the WHD and to educate and raise awareness on risk factors of heart diseases.“This year on WHD, we are asking you to make a promise. A promise to eat more healthily, to get more active, to say no to smoking,” said WHF in a statement.
As part of activities to mark the WHD, cardiologists have charged the general public to adopt a healthy lifestyle so as to prevent the issues of heart diseases ravaging the country. Also, heads of state and government on Thursday committed to 13 new steps to tackle non-communicable diseases (NCDs) including cardiovascular diseases (CVDs), cancers, heart and lung diseases, stroke, and diabetes, and to promote mental health and well being.
CVD is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, heart arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.
According to the WHF and World Health Organisation (WHO), CVD is the leading cause of death and disability in the world; killing 17.5 million people a year. That is a third of all deaths on the planet and half of all NCD-related deaths. Around 80 per cent of these deaths are in low- and middle-income countries where human and financial resources are least able to address the CVD burden.By 2030, almost 23.6 million people will die from CVDs, mainly from heart disease and stroke. These are projected to remain the single leading causes of death.
Triggering these diseases – which manifest primarily as heart attacks and strokes – are tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. These in turn show up in people as raised blood pressure, elevated blood glucose and overweight and obesity, risks detrimental to good heart health.
Director-General of WHO, Dr. Tedros Adhanom Ghebreyesus, said on Thursday: “Today, world leaders have taken a set of landmark steps to beat NCDs. These add up to a historic opportunity to promote health, save lives, and grow economies.”World leaders, on the sidelines of Thursday’s United Nations UN General Assembly (UNGA) meeting in New York, United States (U.S.), agreed to take responsibility themselves for their countries’ effort to prevent and treat NCDs. They also agreed that these efforts should include robust laws and fiscal measures to protect people from tobacco, unhealthy foods, and other harmful products, for example by restricting alcohol advertising, banning smoking, and taxing sugary drinks.
WHO, through the Global Hearts Initiative, is supporting governments around the world to scale-up efforts on CVD prevention and control through three technical packages: MPOWER for tobacco control, SHAKE for salt reduction and HEARTS for the strengthening of CVD management in primary health care. Launched in September 2016, the Global Hearts Initiative has since been rolled out in a number of countries. In those settings health workers are being trained to better deliver tested and affordable measures to protect people from CVDs and help them to recover following a heart attack or stroke. A new global initiative – Resolve to Save Lives – will give renewed impetus to these efforts.
Executive Director, Nigerian Heart Federation (NHF), Dr. Kingsley Akinroye, told The Guardian that the rate of heart diseases is alarmingly going up in Nigeria. This, he said is as a result of low awareness drive and poor healthcare institutions across the nation.
“Our health system is not focused. On high rate of heart diseases, we, as a country are still not prepared for it. At all level of care, we have a lot to do. In the primary healthcare a lot of awareness and promotion has been ongoing by the heart foundation. We have been doing it for the past 25 years, we are making efforts but the impact is still not there. The awareness, the care and prevention are still very poor. NHF is working with the government, regulating and international agencies on what can be done in terms of prevention of heart diseases,” Akinroye said.
On the activities of Foundation to mark the day, Akinroye said: “We started our own celebration since September First in Port Harcourt. We conducted Cardio Pulmonary Resuscitation (CPR) training for societies as an instrument useful in resuscitating one from heart attack. We conducted it for Association of Petroleum Engineers in Nigeria in which their members of staff were trained on how to do that.
“We also gave a lecture on prevention of heart disease and current situation of heart disease in the country. We are also playing the golf tournament this weekend at Ibadan as a further demonstration and also educate people on how to prevent heart diseases.”
Akinroye explained that as an individual, one should be able to know the risk factors, what makes one more prone to heart disease and what can be done. “You should be able to be conscious of your diet. Nutrition is very important. A lot of emphasis should be laid on reduced intake of salt. Salt intake in diet affects the blood pressure; the much intake of salt the higher the risk of high blood pressure and that is number one heart disease in the country. We are also focused on the amount of Trans fat consumed. This is why NHF has been promoting heart awareness and food labeling with some food manufacturers under the permission of The National Agency for Food and Drug Administration and Control (NAFDAC) to make sure food products are labeled, those that contain a lot of Trans fat will not be sold in the market.”
He continued: “We have also have moved ahead in reducing people the opportunity of tobacco use and the federal government has agreed to increase excise duty on alcohol. We are promoting exercise among the populace and towards this extent, this is our fourth year coming out with what is called a report card which is been used in the 52 countries of the world and NHF is one of them, we use this report card to monitor exercise among children and youth.”
On the issue of excise duty on alcohol, Akinroye said: “We have done our job, we are working with the government and some manufactures and the Minister promised and recommended this to the Federal Executive Council and we believe this has been approved. Then as a foundation, we are also waiting for the implementation.”
Akinroye encouraged the public saying: “Heart disease is now with us. It affects everybody. We also must recognise that heart disease is preventable. You can do it yourself, you can regulate the amount of sugar you take, make sure you do not stay in a smoke filled environment, and if your neighbor smokes please ask them to stop. Do not abuse alcohol.”
Akinroye urged Nigerians to always check their blood glucose levels because High blood glucose (blood sugar) can be indicative of diabetes and if it is left undiagnosed and untreated it can put you at increased risk of heart disease and stroke.
“Check your blood pressure. High blood pressure is the number one risk factor for CVD. It is called the ‘silent killer’ because it usually has no warning signs or symptoms, and many people do not realize they have it. Check your numbers. Visit your healthcare professional and ask them to measure your cholesterol levels, weight and body mass index (BMI), as well as your blood pressure and blood glucose. They can then advise you on your CVD risk so you can plan to improve your heart health,” he added.
The NHF boss continued: “Understand the signs and symptoms of a heart attack over 70 percent of all cardiac and breathing emergencies occur in the home when a family member is present and could help a victim. Talk to your healthcare professional about local CPR courses so you can help a loved-one in the event of a heart attack. If you suspect a family member is having a heart attack or stroke, seek medical help immediately. Cholesterol is associated with around four million deaths per year so visit your healthcare professional and ask them to measure your levels and they will be able to advice on your CVD risk so you can plan to improve your heart health.”
He also encouraged the public’s participation to let the government reduce the high cost of high blood pressure drugs. “We are also canvassing that when you have high blood pressure you need to take drugs but the drugs are costly. We need the government to reduce the high cost of high blood pressure drugs. They are unaffordable a lot of our people cannot afford it. Let us reduce the cost of these drugs because a lot of them are imported to the country you can do a lot as government by reducing the excise duty and also encourage local manufacture to manufacture drugs for heart disease,” he said.
Similarly, a Paediatric Cardiologists at Gray Cardiology Centre, Lagos, Dr. Emeka Ugwu, explained that world heart day is a day set aside usually to discuss the burden or problems of hearts diseases and blood vessel problems and also enlightening people about the issues that involve the heart and blood vessels.
He said as people are eating things that are not as natural as what our fore fathers ate, we are bound to situation where we have more heart problems including heart failures, hypertension and all that. Ugwu continued: “In children, because of industrialization, we are having more pollution and increased incidence of heart problem within the children. Conversely, we are fortunate that, just as industrialization is throwing up things that can predispose people to anomaly, we also have technology to be able to address that.”
He added: “The Gray Cardiology Centre is able to provide those opportunities to reduce medical tourism that continues to drain billions of naira from Nigerians. It is from our notes to discuss the burden and problem of heart diseases in Nigeria and current opportunities that is available for our people to access the information, preventive care and curative care of heart problems.”
The expert blamed the rise in congenital heart disease on paucity of data and lack of skilled personnel to diagnose and identify heart problems in children. He continued: “Generally, we know that globally, the frequency is almost constant, about one percent of all birth will have congenital heart diseases and in Nigeria we have about seven to eight million babies that is around 700, 000 to 800, 000 babies would have congenital heart disease.
“Majority of them we actually do not know the causes but we know some risk factor that can predispose into having congenital heart disease. We know that some infections, mostly viral infections that parents have especially mothers when they are pregnant might affect the child and the child will have a structural heart problem. If there is a family history, a child has been born with the structural heart problem, it increases the risk of another child been born with it. It is important for any family that has child with structural heart problem to screen the subsequent children so as to detect it on time.
“Another risk factor is diabetes, if the mother is diabetic, it increases the risk of some structural heart diseases in the children, and some skin problem can also be a pointer that a child might have heart problem from when he is born by the woman that has it. “Generally we will not be able to say for sure the other one is drugs. Some medications when the mothers take them especially within three months of getting pregnant the child can have a hole in the heart. Majority of the cases are due to ignorance, Ugwu said.
The paediatric cardiologist expressed worries over the state of the health sector saying: “The first cardiac surgery in Nigeria was done in 1974. We expect by now we should have gone far in doing things like this and there is this issue of brain drain, a lot of doctors leaving the country, poor training, lack of government funding and the expected developmental progress is not there.”
Ugwu continued: “But currently, we have a lot of Nigerians returning and also many Nigerians going out to acquire these skills. Our collective responsibility is to tell Nigerians that some of these things are available in Nigeria so as to curtail medical tourism.“There are some policies of the government aimed at improving the health of Nigerians. If I would suggest anything, it would be health insurance to be provided for Nigerians. Health insurance is very important, universal coverage is very important so that Nigerians can access healthcare.
“Doctors working at the local level should also be trained and then have the capacity to refer those cases. If people are not empowered to access care they would be always be complications. I think the government is doing a lot to refurbish the primary healthcare and empowering Nigerians to be able to access this care so that people will not pay out of pocket especially for cardiac problems.”
Furthermore, a Consultant Cardiologist, Dr. Kenneth Ochulor, said: “Health is something we cannot negotiate by choosing a lower quality over high quality. “In general health problems can be prevented, because we know if you do not have this problem from childhood then you are looking at something else going on in your body that is affecting you.”
Ochulor continued: “So our task is to identify what went wrong and address it. Lifestyle habits like heavy alcoholic intake and cigarette use should be avoided. The best way of avoiding heart diseases is finding a way to preventing these conditions from being established and eventually established, we find a way to address them early enough to avoid being damaged the heart of the person.“Again, lifestyles conditions that lead to gaining a lot of weight, sedentary lifestyles jobs that do not get you to move about lack of exercises those things pose as a risk. So the part of it that an individual have some control over peoples should have control over their diet and weight and ability to exercise so as to prevent heart problems.”
Credit: The Guardian