In Her Lifetime Female Morbidity and Mortality in Sub-Saharan Africa (1996) / Chapter Skim
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7 Cardiovascular Diseases, Cancers, and Chronic Obstructive Pulmonary Diseases
7 Cardiovascular Diseases, Cancers, and Chronic Obstructive Pulmonary Diseases
Pages 152-168
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From page 152... ...
The historic dominance of the communicable diseases and the emphasis to date on their treatment and control partially explain the lack of information and reliable data on the noncommunicable diseases. Lack of interest and appropriately trained medical personnel, especially in epidemiology, and the absence of coherent policies concerning data collection, information management, and research in general, however, are more critical in explaining the present dearth of understanding concerning the large and important category of noncommunicable and chronic diseases (Commission on Health Research for Development, 1990; Feachem and Jamison, 19915.
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From page 153... ...
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)
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From page 154... ...
As in the case of cardiovascular disease, the incidence of stroke increases with age, and this may again place older Sub-Saharan women at increased risk (Bam and Yako, 19843. Factors Influencing Coronary Artery Disease and Stroke Risk Smoking In addition to its implications in CVD, smoking is a pivotal risk factor in a large number of chronic disorders, with significant impact on burdens of morbidity and mortality.
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From page 155... ...
As for the behavior of specific subpopulations, a group of great size and particular risk and, obviously, a primary matter of concern for this report is the world's population of girls and women. About 10 percent of African women report that they smoke cigarettes daily (WHO, 1992~.
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From page 156... ...
Risk factors for hypertension include a positive family history of the disorder, increased body mass, obesity, and elevated salt intake (Dyer et al., 1994; NRC, 1989; Stamler et al., 1991~. Race has also been shown to be an important risk factor; many studies demonstrate that blood pressure is higher and hypertension more prevalent among blacks of African origin than in Caucasians living in similar environments (DHHS, 1986; Stamler et al., 19759.
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From page 157... ...
There is a strong association between obesity and other cardiovascular risk factors, including hypertension and metabolic disorders such as diabetes (Bonham and Brock, 1985; Gillum and Grant, 1982; Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, 1986; Sims and Berchtold, 1982~. Although relatively few studies have involved Sub-Saharan population groups (Alade and Ezeokeke, 1990)
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From page 158... ...
, and optimum case management includes screening for GDM in any pregnant woman, because the consequences of unrecognized or untreated GDM include increased fetal and neonatal loss and higher neonatal and maternal morbidity. Oral Contraceptive Use The use of contraceptive pills has increased substantially among Sub-Saharan African females, especially in the middle and upper socioeconomic groups who can afford their cost.
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From page 159... ...
So far, there are no valid epidemiologic data to link the use of oral contraceptives by black Africans with an increased risk factor of CVD. The risk factors discussed above do not constitute an exhaustive listing of all the factors implicated in the general picture of all risks for cardiovascular disorders.
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From page 160... ...
Dietary factors have been implicated as a possible contributor to breast cancer, and socioeconomic factors may also be producing dietary modifications that could be meaningful (Howe et al., 1990; Lubin et al., 1986; WHO, 1990' It may also be, as conditions improve and screening programs are developed, that the combination of all these changes with improvements in casefinding will generate higher frequencies, so that breast cancer may be found to be more common than cervical cancer (Miller, 1992~. As with the other forms of gynecologic cancer in Sub-Saharan Africa, diagnosis in most cases of breast cancer is made relatively late in the course of the disease, significantly reducing survival.
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From page 161... ...
In addition, chronic tropical ulcers have a tendency to degenerate into malignant skin-based lesions (Huts, l991J. By virtue of their daily agricultural and other domestic duties, Sub-Saharan African women can be expected to be prone to such ulcers, and they are consequently at risk for this particular lesion.
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From page 162... ...
Cigarette Smoking The relative increase in smoking prevalence in Sub-Saharan African females described earlier heralds increasing COPD incidence in this group. Prospective studies in other regions of the world have demonstrated higher COPD mortality and earlier disease onset in cigarette smokers (Peters and Ferris, 1967)
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From page 163... ...
Table 7-7 indicates the approximate ages at which chronic diseases and their sequelae occur in Sub-Saharan African females. The following conclusions can be drawn on the basis of existing data: · Because of their relatively early age of onset and persistence across the life span, the cardiovascular disorders hypertension, rheumatic heart disease, and cardiomyopathies associated with pregnancy appear to be among the chronic disorders that may most adversely affect female health status in the region.
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From page 164... ...
Po s tme n op au se (age 45+) Hypertension Hypertension Hypertension Rheumatic heart Rheumatic heart Rheumatic heart disease Cardiomyopathies associated di sease Cardiomyopathies associated with pregnancy with pregnancy Gestational Gestational diabetes mellitus diabetes mellitus Breast cancer (cancer of the cervix di sease Breast cancer Cancer of the cervix Leukemias and Leukemias and Leukemias and Iymphomas Iymphomas Skin cancer lymphomas Skin cancer Bladder cancer Bladder cancer Chronic obstructive pulmonary diseases RESEARCH NEEDS · There is an urgent need to create or support existing units concerned with data collection, evaluation, and surveillance of the major chronic disorders in Sub-Saharan Africa.
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From page 165... ...
Special attention should be directed to identification of risk factors for smoking initiation in adolescent females and to the development of intervention programs appropriate to the target audience. · The higher prevalence and mortality rates for rheumatic heart disease in Sub-Saharan African females observed in hospital case series is striking and needs to be confirmed.
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From page 166... ...
1982. Coronary heart disease in Black populations, II: Risk factors.
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From page 167... ...
1974. Coronary heart disease.
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From page 168... ...
1988. Rheumatic Fever and Rheumatic Heart Disease.
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