Cardiovascular Disease Healthcare Utilization in Sub-Saharan Africa: A Scoping Review
Herbert Chikafu1, Moses J Chimbari2
1School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa. chikafuh@gmail.com.
Insights
Cardiovascular disease (CVD) care access in Sub-Saharan Africa is limited, especially for rural and low socioeconomic populations. Improving healthcare provision is crucial for addressing the rising CVD burden and ensuring continuum of care.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Sub-Saharan African (SSA) countries experience increasing cardiovascular disease (CVD) burdens due to complex transitions.
- CVD risk factors are rising, overlapping with high infectious disease prevalence in SSA.
- Understanding CVD healthcare utilization is critical for addressing this growing public health challenge.
Purpose of the Study:
- To systematically review and synthesize the determinants and levels of cardiovascular disease healthcare utilization in Sub-Saharan Africa.
- To identify gaps in CVD care access and provision within the region.
Main Methods:
- Systematic literature search of major databases (2008-2018) using combined CVD and utilization indicators.
- Inclusion of 18 quantitative studies from eight SSA countries, primarily focusing on inpatient stroke care.
Main Results:
- Two-thirds of stroke patients sought care within 24 hours; hospital length of stay varied significantly (6-81 days).
- Cardiovascular disease admissions show an increasing trend relative to total hospital admissions.
- Physiotherapy service coverage is limited and inconsistent; utilization is negatively associated with rural residence and socioeconomic status.
Conclusions:
- Significant disparities exist in CVD healthcare access and utilization in SSA.
- Limited healthcare provision, particularly for rural and lower socioeconomic groups, hinders the CVD continuum of care.
- Urgent expansion of healthcare services is needed to address the escalating CVD burden in Sub-Saharan Africa.
Abstract:
Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008⁻2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.
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