Capacity for diagnosis and treatment of heart failure in sub-Saharan Africa
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Published on: October 31, 2010
Selma Carlson1, Herbert C Duber2,3, Jane Achan4
1Division of Cardiology, University of Washington, Seattle, Washington, USA.
Insights
Few health facilities in Kenya and Uganda can diagnose and treat heart failure. Limited availability of cardiac diagnostic tools and common medication stock-outs hinder effective heart failure management in sub-Saharan Africa.
Area of Science:
- Cardiology
- Public Health
- Health Systems Research
Background:
- Heart failure presents a significant disease burden in sub-Saharan Africa (SSA).
- Effective management strategies for heart failure in SSA are lacking.
- Understanding diagnostic and treatment capacity is crucial for improving care.
Purpose of the Study:
- To assess the capacity for diagnosing and treating heart failure in Kenya and Uganda.
- To inform policy and interventions for heart failure management in SSA.
Main Methods:
- Nationally representative surveys of 197 facilities in Uganda and 143 in Kenya.
- Analysis of availability of cardiac diagnostic technologies (radiography, ultrasound, ECG).
- Assessment of select heart failure medications (β-blockers, ACE inhibitors, furosemide) and stock-out frequency.
Main Results:
- Functional radiography, ultrasound, and ECG were available in less than half of surveyed hospitals.
- Heart failure medication packages were available in 49% of Kenyan and 77% of Ugandan hospitals.
- ACE inhibitors were scarce, and nearly one-third of hospitals experienced stock-outs of essential medications.
Conclusions:
- Health facilities in Kenya and Uganda have limited capacity for diagnosing and managing heart failure.
- Frequent medication shortages and stock-outs impede patient care.
- Increased investment in cardiac care infrastructure and supply chains is urgently needed to address the growing heart failure burden.
Objective:
Heart failure is a major cause of disease burden in sub-Saharan Africa (SSA). There is an urgent need for better strategies for heart failure management in this region. However, there is little information on the capacity to diagnose and treat heart failure in SSA. We aim to provide a better understanding of the capacity to diagnose and treat heart failure in Kenya and Uganda to inform policy planning and interventions.
Methods:
We analysed data from a nationally representative survey of health facilities in Kenya and Uganda (197 health facilities in Uganda and 143 in Kenya). We report on the availability of cardiac diagnostic technologies and select medications for heart failure (β-blockers, ACE inhibitors and furosemide). Facility-level data were analysed by country and platform type (hospital vs ambulatory facilities).
Results:
Functional and staffed radiography, ultrasound and ECG were available in less than half of hospitals in Kenya and Uganda combined. Of the hospitals surveyed, 49% of Kenyan and 77% of Ugandan hospitals reported availability of the heart failure medication package. ACE inhibitors were only available in 51% of Kenyan and 79% of Ugandan hospitals. Almost one-third of the hospitals in each country had a stock-out of at least one of the medication classes in the prior quarter.
Conclusions:
Few facilities in Kenya and Uganda were prepared to diagnose and manage heart failure. Medication shortages and stock-outs were common. Our findings call for increased investment in cardiac care to reduce the growing burden of heart failure.
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