Background Little is known about community knowledge of myocardial infarction symptoms and perceptions of self-risk in sub-Saharan Africa. Methods A community survey was conducted in northern Tanzania, where the prevalence of cardiovascular risk factors is high. Households were selected randomly in a population-weighted fashion and surveys were administered to self-identified household healthcare decision-makers. Respondents were asked to list all symptoms of a heart attack and asked whether they thought they had a chance of suffering a heart attack. Associations between participant sociodemographic features and responses to these questions were assessed with Pearson's chi-squared and the Student t test. Results There were 718 survey participants, with median (IQR) age 48 (32, 62) years. Of these, 115 (16.0%) were able to identify any conventional symptom of a heart attack, including 24 (3.3%) respondents who cited chest pain as a possible symptom. There was no association between ability to identify a conventional symptom and gender, level of education, socioeconomic status, urban residence, or age. Of respondents, 198 (27.6%) thought they had a chance of suffering a heart attack. Older respondents were more likely to perceive themselves to be at risk ( P < .001), but there was no association between perception of self-risk and gender, level of education, socioeconomic status, or urban residence. Conclusions In northern Tanzania, knowledge of myocardial infarction symptoms is poor among all segments of the population and only a minority of residents perceive themselves to be at risk of this disease. Educational interventions regarding ischemic heart disease are urgently needed.

BackgroundSelf-treatment with antimicrobials is common in sub-Saharan Africa. Little is known about the prevalence of this practice where malaria transmission intensity is low, and little is known about the prevalence of self-treatment with other medications such as antihypertensives and antihyperglycemics.MethodsA two-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified healthcare decision-makers from randomly selected households were asked to report instances of self-medication without a prescription in the preceding year. Associations between self-treatment and sociodemographic characteristics were assessed with Pearson’s chi-squared and the Student’s t-test.ResultsA total of 718 participants completed the survey, and 344 (47.9%) reported any household member obtaining medication without a prescription. Of these, 85 (11.8%) obtained an antimicrobial and four (0.6%) obtained an antihypertensive or antihyperglycemic. Of respondents reporting self-treatment, 306 (89.0%) selected the medication themselves. Self-treatment with antimicrobials was associated with post-primary education (OR 1.95, 95% CI 1.22–3.16, p=0.005), younger age (43.1 vs 48.7 years, p=0.007) and higher socioeconomic status score (0.42 vs 0.34, p=0.023).ConclusionsSelf-treatment with antimicrobials in an area of low malaria transmission intensity was uncommon and self-treatment with antihypertensives and antihyperglycemics was rare.

Background Little is known about community perceptions of chest pain and healthcare seeking behavior for chest pain in sub-Saharan Africa. Methods A two-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified household healthcare decision-makers from randomly selected households were asked to list all possible causes of chest pain in an adult and asked where they would go if an adult household member had chest pain. Results Of 718 respondents, 485 (67.5%) were females. The most commonly cited causes of chest pain were weather and exercise, identified by 342 (47.6%) and 318 (44.3%) respondents. Two (0.3%) respondents identified ‘heart attack’ as a possible cause of chest pain. A hospital was selected as the preferred healthcare facility for an adult with chest pain by 277 (38.6%) respondents. Females were less likely to prefer a hospital than males (OR 0.65, 95% CI 0.47–0.90, p = 0.008). Conclusions There is little community awareness of cardiac causes of chest pain in northern Tanzania, and most adults reported that they would not present to a hospital for this symptom. There is an urgent need for educational interventions to address this knowledge deficit and guide appropriate care-seeking behavior.