Cardiovascular disease risk profile and management among people 40 years of age and above in Bo, Sierra Leone: A cross-sectional study

Abstract

Introduction Access to care for cardiovascular disease risk factors (CVDRFs) in low- and middle-income countries is limited. We aimed to describe the need and access to care for people with CVDRF and the preparedness of the health system to treat these in Bo, Sierra Leone. Methods Data from a 2018 household survey conducted in Bo, Sierra Leone, was analysed. Demographic, anthropometric and clinical data on CVDRF (hypertension, diabetes mellitus or dyslipidaemia) from randomly sampled individuals 40 years of age and above were collected. Future risk of CVD was calculated using the World Health Organisation–International Society of Hypertension (WHO-ISH) calculator with high risk defined as >20% risk over 10 years. Requirement for treatment was based on WHO package of essential non-communicable (PEN) disease guidelines (which use a risk-based approach) or requiring treatment for individual CVDRF; whether participants were on treatment was used to determine whether care needs were met. Multivariable regression was used to test associations between individual characteristics and outcomes. Data from the most recent WHO Service Availability and Readiness Assessment (SARA) were used to create a score reflecting health system preparedness to treat CVDRF, and compared to that for HIV. Results 2071 individual participants were included. Most participants (n = 1715 [94.0%]) had low CVD risk; 423 (20.6%) and 431 (52.3%) required treatment based upon WHO PEN guidelines or individual CVDRF, respectively. Sixty-eight (15.8%) had met-need for treatment determined by WHO guidelines, whilst 84 (19.3%) for individual CVDRF. Living in urban areas, having education, being older, single/widowed/divorced, or wealthy were independently associated with met need. Overall facility readiness scores for CVD/CVDRF care for all facilities in Bo district was 16.8%, compared to 41% for HIV. Conclusion The number of people who require treatment for CVDRF in Sierra Leone is substantially lower based on WHO guidelines compared to CVDRF. CVDRF care needs are not met equitably, and facility readiness to provide care is low.

Prevalence of Hypertension, awareness, treatment, and blood pressure control in Sierra Leone: A systematic review and meta-analysis

“…Our finding is comparable to most of the studies conducted in the general population but significantly lower than the findings of studies conducted in hospital settings[42]. Notably, the prevalence of hypertension was higher in the older population [32] and among patients with certain medical conditions (for example, stroke) [42], with the lowest prevalence rate reported in young university students (12%)[31]. To date, there has not been any meta-analysis on the prevalence of hypertension in Sierra Leone to compare our findings.…”

“…A total of 15 studies were ultimately included in this systematic review and meta-analysis. (Figure 1) The characteristics of the 15 studies [23,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] included in this review are summarized in Table 1. A total of 14,707 participants aged ≥ 15 years were included in all fifteen studies, with sample sizes ranging from 87 to 3944.…”

Association of sleep characteristics with cardiovascular disease risk in adults over 40 years of age: a cross-sectional survey

“…Participants without cardiovascular disease information were excluded; 3. Participants under the age of 40 were excluded ( 17 ). All remaining participants were included in the study.…”