Assessment of risk of peripheral vascular disease and vascular care capacity in low- and middle-income countries

Abstract

Introduction This study aimed to describe national peripheral vascular disease (PVD) risk and health burden and vascular care capacity in Ghana. The gap between PVD burden and vascular care capacity in a low- and middle-income country (LMIC) is defined and capacity improvement priorities identified. Methods Data to estimate PVD risk factor burden were obtained from: i) World Health Organization’s Study on Global Ageing and Health (SAGE), Ghana; and ii) Institute of Health Metrics and Evaluation Global Burden of Disease database (IHME GBD). In addition, a novel nationwide assessment of vascular care capacity was performed, with 20 vascular care items assessed at 40 hospitals in Ghana. Factors contributing to specific item deficiency were also described. Results From the SAGE database, there were 4,305 respondents aged at least 50 years with data to estimate PVD risk. Out of these 57% were at moderate to high PVD risk with ≥3 risk factors, thus giving 1,654,557 persons when extrapolated nationally. Using IHME GBD data, the estimated disability-adjusted life years incurred from PVD increased 5-fold from 1990 to 2010 (1.3 to 3.2 per 100,000 persons, respectively). Vascular care capacity assessment demonstrated marked deficiencies in items for diagnosis, perioperative and vascular surgical care. Deficiencies were most often due to absence of equipment, lack of training and technology breakage. Conclusion Risk factor reduction and management as well as optimization of current resources are paramount to avoid the large burden of peripheral vascular disease falling on healthcare systems in low- and middle-income countries that are not well equipped to handle vascular surgical care, and for which rapid development of such capacity would be difficult and expensive.

Collaborative Approach to the Creation of an Arteriovenous Fistula on a US Navy Hospital Ship

“…Chronic medical conditions, such as CKD and peripheral vascular disease, are increasing worldwide and are projected to surpass the morbidity from acute infectious disease. 4 Of the over 200 million patients with peripheral vascular disease worldwide, 70% are estimated to live in LMICs. In most of these countries, there is 1 general surgeon per 100 000 people and no vascular surgeon.…”

“…3 There is an increasing risk for the development and sequelae of vascular disease; however, these nations frequently lack vascular capabilities. 4 The Kidney Disease Quality Outcomes Initiative, implemented in 1997, advocates for early arteriovenous fistula (AVF) creation in an attempt to decrease morbidity and mortality in patients with end-stage renal disease and is the standard of care in the United States. 5 Unfortunately, these same standards are not currently attainable in low-and middle-income countries (LMICs).…”

Consensus recommendations for essential vascular care in low- and middle-income countries

“…5,6 While prevention, risk-factor reduction and a public health approach is fundamental to reducing the global NCD burden, planning NCD-related healthcare capacity improvements in LMICs is also important. 7 …”

“…17–19 Inopportunely, the growing burden of vascular conditions falls on health systems that are not well equipped to provide essential trauma care, manage challenging vascular problems, or care for the unique requirements of the growing geriatric population. 7,20,21 Sustaining these deficiencies is a lack of recommendations for LMIC healthcare systems to follow regarding the essential functions and resources for vascular care.…”