Cardiac Disease Patterns in Northern Malawi: Epidemiologic Transition Perspective

Abstract

BackgroundCardiovascular disease (CVD) is a strongly emerging problem in developing countries. The documentation and prediction of CVD patterns are important for policy makers if actions are to be taken to curb this problem. We aimed to document the current CVD patterns in Malawi, and associate these patterns to the theory of epidemiologic transition as a means of predicting future CVD patterns.MethodsWe retrospectively analyzed the data recorded in the register of the cardiac clinic in Mzuzu Central Hospital-the only cardiac clinic run by a cardiologist in Malawi-from 2001 through 2005. The findings were interpreted in the context of the epidemiologic transition theory.ResultsOut of the 3908 new Malawian patients included in the 5-y period register, 34% had valvular heart disease (mainly rheumatic heart disease (RHD)); 24%, hypertensive heart disease; 19%, cardiomyopathies; and 14%, pericardial diseases. The other CVD patterns included congenital heart disease and arrhythmias, each representing 4% of the registered patients. Among the 1% comprising other CVD patterns, 3 cases were documented to have coronary heart disease, all of which happened in 2005.ConclusionMalawi is in the stage of receding pandemics, which is characterized by CVD patterns predominated by RHD, cardiomyopathies, and hypertensive heart disease. However, continuous observation is required to detect signs of emerging “degenerative-related” CVD patterns, which is another stage in the epidemiologic transition.

Pattern of Cardiovascular Diseases as Seen in an Out-Patient Cardiac Clinic in Ghana

“…South West Ethiopia had cardiomyopathy. This result is also in agreement with a study in Malawi by Soliman et al [34]; they found the prevalence of cardiomyopathy to be 9.8%. In a study of 708 cardiac patients at the National Cardiothoracic Centre at the Korle Bu Teaching Hospital, Accra, Amoah et al [9] reported a comparable proportion of cases with cardiomyopathy (14.6%).…”

“…The disparity could be partly due to difference in case definition, sample size and the population studied. The major risk factors for coronary artery disease identified in our cardiac patients were hypertension, diabetes mellitus and obesity; which compares well with previous studies done in Ghana [9] and some other African countries [34].…”

“…The low prevalence of congenital heart disease reported is also similar to what was noted from previous reports from other centres in Cameroon [12] and Malawi [34] with the findings of 2.3% and 4.0% respectively. It was also close to the 1.8% found by Ogah et al among 1441 cardiac patients referred for echocardiography in Nigeria [27].…”

“…Rheumatic heart disease was the most preponderant valvular heart disease, accounting for 70.6% of cases in our study, a finding similarly reported in Ghana and other sub-Saharan Africa settings [9] [13] [19] [27] [34]. Rheumatic heart disease remains a major cause of cardiovascular disease in Ghana, with mitral valve lesion as the most common rheumatic valvular heart disease [9].…”

“…This finding is among the highest in the series of published data on spectrum of CVD across the various centres [9] [13] [34]. Our finding is comparable to similar studies done in Northern Malawi [34] and South West Ethiopia [13] which reported prevalence of 4.0% and 3.5% respectively in patients with cardiovascular diseases but understandably higher compared to the finding of 1.4% at the National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana [9]. Difference in the methodology may have contributed to the different prevalence rates.…”