It has been suggested that the prevalence of coronary artery disease (CAD) is steadily increasing in sub-Saharan Africa. To address this issue, we conducted a Medline search of English language articles on cardiovascular diseases-and specifically CAD in Africa- from 1966 to 1997. The prevalence of CAD and related complications is relatively low in most regions in Africa compared to that obtained in the economically developed countries, although the situation is rapidly changing due to trends in urbanization, changes in lifestyle, acquisition of technology and the increasing numbers of tertiary care institutions. There are variations in reported prevalence rates within the different regions, but there is an upward trend in all the regions of the sub-Saharan Africa. This trend is believed to be related to the increasing frequencies of CAD risk factors in the subcontinent.

Trends in Coronary Artery Disease and Associated Risk Factors in sub-Saharan Africans

Endomyocardial fibrosis is a relatively common form of heart disease in Uganda (Davies, 1948; Shaper and Williams, 1960) and accounts for some 10 per cent of heart disease seen at necropsy in Kampala (Davies, 1961). It is characterized in the established condition by fibrosis in the endocardium and subjacent myocardium affecting particularly the inflow tract and the apex of one or both ventricles. The aetiology of this disorder is not known, and hypotheses have been put forward in attempts to incriminate virus or filarial infections, plantain diets, and rheumatic heart disease. The disorder has also been described in West Africa, Ceylon, South India, and Central Africa, and wellauthenticated cases have been seen in Europeans resident in tropical areas (Brockington, Olsen, and Goodwin, 1967). Mulago Hospital, Kampala, is situated in Buganda, the largest province of Uganda, and about half the patients admitted to the hospital belong to the local Ganda tribe (Fig. 1). There is also a large immigrant population in Buganda, coming in particular from Rwanda and Burundi (herein referred to as 'Rwandans') and from the Western Province of Uganda (Kigezi, Ankole, Toro, and Bunyoro districts). An analysis of the tribal origins of cases of endomyocardial fibrosis coming to necropsy at Mulago Hospital in the period 19501961 showed a preponderance of this condition among those groups immigrant to Buganda, in particular those originating from Rwanda and Burundi. The condition was far less common than expected among the indigenous Ganda people (Shaper and Coles, 1965). This analysis of the tribal origins of subjects with endomyocardial fibrosis has now been extended to cover the period 1950-1965, and a similar analysis

https://heart.bmj.com/content/heartjnl/30/3/391.full.pdf

Necropsy study of endomyocardial fibrosis and rheumatic heart disease in Uganda 1950-1965.

Hypertension and related complications appear, from clinical impression, to be increasing problems in urban Ghanaians. In early 1973 we conducted a blood pressure survey in 20 rural Ghanaian villages to determine the prevalence of hypertension, in comparison with studies done in Accra residents and black Americans. Rural Ghanaians had mean systolic and diastolic blood pressures which were lower at all ages than the urban groups. 2·5% of the subjects aged 16 to 54 years had diastolic blood pressures of 95 or higher mm Hg. These findings are discussed in view of the proposed hypertension control programme in Accra. We conclude that hypertension is not a significant health problem in rural Ghanaians and that large-scale hypertension case-finding and intervention programmes should be confined to urban populations.

Blood pressure distribution in a rural Ghanaian population

Despite a safe and effective vaccine there are approximately 200000 cases including 30000 deaths due to yellow fever virus (YFV) each year of which 90% are in Africa The natural history of YFV has been well described especially in West Africa but in East Africa yellow fever (YF) remains characterised by unpredictable focal periodicity and a precarious potential for large epidemics Recent outbreaks of YF in Kenya (1992-1993) and Sudan (2003 and 2005) are important because each of these outbreaks have involved the re-emergence of a YFV genotype (East Africa) that remained undetected for nearly 40 years and was previously unconfirmed in a clinically apparent outbreak In addition unlike West Africa and South America YF has yet to emerge in urban areas of East Africa and be vectored by Aedes (Stegomyia) aegypti This is a significant public health concern in a region where the majority of the population remains unvaccinated This review describes historical findings highlights a number of disease indicators and provides clarification regarding the natural history recent emergence and future risk of YF in East Africa

The enigma of yellow fever in East Africa.

Epidemiological and laboratory characterization of a yellow fever outbreak in northern Uganda, October 2010–January 2011

449 patients with heart disease were admitted to the Mulago Hospital, Kampala, each patient for the first time, during the 12 months from 1 October 1962. In order of importance the common disorders were rheumatic heart disease, hypertension or acute nephritis with heart failure, idiopathic cardiomegaly, endomyocardial fibrosis, and syphilitic heart disease. Less common were cor pulmonale, anaemia with heart failure, congenital heart disease and pericardial disease. Patients with endomyocardial fibrosis were mainly immigrants from Rwanda and Burundi or from the adjoining tribes. No other disease showed a particular tribal incidence. The importance of cardiac disease as a cause of admission to the Mulago Hospital has not changed over 5 years but the pattern of disease shows a decrease in syphilitic heart disease and an increase in cor pulmonale. Heart disease is of equal importance as a hospital problem in Uganda, Kenya, Nigeria and Rhodesia, but the incidence of the separate diseases differs in these areas.

A study of heart disease in the Mulago Hospital, Kampala, Uganda

Yellow Fever in Central Uganda, 1964. Part II. Report of a Fatal Case.

Glucose tolerance tests were carried out on 37 healthy male Ugandan Africans, with a loading dose of 50 g. All estimations were made on capillary blood. The results have been compared with those of matched British males. The Ugandan curves tended to be lower and to change less abruptly than the British. 15 other Ugandan subjects were studied after 50 g. of carbohydrate given in the form of banana. The response obtained was similar to that after glucose but the fall in blood sugar was slower. The pancreas weights of 1449 Ugandan Africans coming to autopsy at the Mulago Hospital, Kampala, were studied. The weights ranged from 9 to over 180 g., most between 70 and 129 g. There is a much wider range in pancreas weight of the Ugandan African than has been found in Britain and Jamaica. The pancreases of 26 Ugandan diabetics were also studied and of these 8 were calcified, 9 markedly fibrosed, and 2 neoplastic; none was small.

Studies of normal carbohydrate tolerance in the Ugandan African.

18 subjects in heart failure due to idiopathic cardiomegaly were admitted to a trial to test the value of prolonged complete bed rest, coupled with a high protein diet, vitamin supplements and standard measures of treatment of heart failure. 10 completed 6 months or more in bed and 5 showed a reduction in heart size. 4 demanded discharge before 6 months in hospital had been completed, and of these 1 showed a reduction in heart size. 5 died in hospital. The relationship of improvement to mode of onset and clinical findings on admission is discussed.

J.A. Tulloch

Papers

A study of heart disease in the Mulago Hospital, Kampala, Uganda

Yellow Fever in Central Uganda, 1964. Part II. Report of a Fatal Case.

Studies of normal carbohydrate tolerance in the Ugandan African.

Prolonged bed rest in the treatment of idiopathic cardiomegaly