TABLE 7-1 Noncommunicable Diseases in Sub-Saharan Africa: Gender-Related Burden

Disorder

Exclusive to Females

Greater for Females than for Males

Burdens for Females and Males Comparable, but of Particular Significance for Females

Cancer

     

Breast

 

X

 

Uterus, ovary, choriocarcinoma

X

   

Cervix

X

   

Skin

 

X

 

Bladder

 

X?

 

Cardiomyopathies associated with pregnancy

X

   

Gestational diabetes mellitus

X

   

Rheumatic heart disease

 

X

 

NOTE: Significance is defined here as having an impact on health that, for any reason—biological, reproductive, sociocultural, or economic—is different in its implications for females than for males.

in males and females, but show a disproportionate burden in females. The other four disorders—including gestational diabetes mellitus; the cardiomyopathies associated with pregnancy; and cancers of the uterus, ovary, and cervix and chriocarcinoma—are unique to females. The other major chronic diseases covered in this chapter currently show no differences in occurrence or outcome by gender; this may reflect inadequacies in the evidentiary base, as well as a possible true lack of gender-specific burden.

CARDIOVASCULAR DISEASES

Emerging Problems
Coronary Artery Disease

The frequency of coronary artery disease (CAD) and related complications in the Sub-Saharan region is much lower than that in developed countries, and CAD is only infrequently the reason an individual is hospitalized for cardiovascular problems (Bertrand et al., 1991; Hutt, 1991; Ticolat et al., 1991) (see Tables 7-2 and 7-3). Nevertheless, recent trends in urbanization, lifestyle changes, and acquisition of appropriate technology are thought to be responsible for what seems to be an increasing number of reports and hospitalizations for this condition (Hutt, 1991; Ticolat et al., 1991). Approximately 6 percent of all admissions into a cardiovascular unit in Côte d'Ivoire between 1988 and 1990 were for CAD; the frequency about a decade ago was less than 3 percent in that same unit (Bertrand, 1991; Bertrand et al., 1991).

In all the studies cited above, myocardial infarction, and CAD in general, are more common in men than in women. Although a direct extrapolation to Sub-Saharan African women cannot be made, it has been shown in some populations that while survival rates with CAD are similar in black men and women, the prognosis is considerably worse in black women for reasons that are not well understood (Liao et al., 1992; Tofler, et al., 1987; Willerson et al., 1987). Because Sub-Saharan women tend to live longer than men (see Appendix), studies will be needed to determine if this added longevity produces a selective effect.



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