In this week’s Thought Leadership piece, guest writer, Cardiologist Oyere Onuma highlights the alarming increase in cases of heart disease and related illnesses in Nigeria, and calls for both better government policies to help address the problem, and more active citizen awareness of the very real danger looming for Nigeria if we do nothing now about heart disease.
In June 2016, Stephen Keshi, former Super Eagles head coach, died at age 58 of a suspected cardiac arrest. Four days later, Shuaibu Amodu, another former Super Eagles coach, was found dead in his bed, aged 54, after complaining of chest pains the night before. There are countless stories of other young Nigerians who have just apparently “slumped and died.” These stories all affirm a growing epidemic of heart disease in Nigeria and other low and middle-income countries.
Previously thought to be a disease of developed or high-income countries, cardiovascular disease – namely heart attacks and strokes – have been making their slow but inevitable and deadly rise in Nigeria. According to data from the World Health Organization, over half a million Nigerians died from non-communicable diseases (NCDs) in 2012, and 1 out of every 5 Nigerian adults over the age of 30 will likely die prematurely from NCDs, including cardiovascular diseases. In terms of risk factors for heart disease, 35% of Nigerian adults had elevated blood pressures in 2008, another 6.5%, mostly women, were obese.
These numbers are likely to increase substantially in the near future given the significant changes in our lifestyles and habits that are making us more susceptible to these diseases. When you add this to the prevailing situation of a very weak health sector in Nigeria, which lacks the capacity and needed human and financial resources to prevent and treat cardiovascular disease and its risk factors, the situation becomes even more dire. If comprehensive steps are not taken, at all levels, including the individual, the health system, and government policies, then the stories young people dying in their most productive years from cardiovascular diseases will continue.
The majority of heart disease and stroke is preventable. Cardiovascular risk factors are well known. They include risks tied to behaviours such as tobacco use, and a lack of physical activity which can lead to being overweight and becoming obese, metabolic risks such as elevated blood pressure, blood cholesterol, and diabetes. Comprehensive action in population-based interventions, as well as interventions in the health system, can significantly reduce the burden of cardiovascular diseases. This has been seen in high-income countries such as the United States, Canada, and Western Europe, where deaths from cardiovascular diseases have been significantly reduced over the last 20 years. There is a chance to close the gap between our extensive knowledge of how to prevent and treat cardiovascular disease and the current practice, or lack thereof, in Nigeria.
On the population and policy level, we need to institute stronger enforcement of existing tobacco legislation Although the Nigerian Tobacco Control Act was signed into action in 2015, several of its provisions were too weak and its implementation in Nigeria by the Federal Ministry of Health has been lacking. The ban on smoking in public places needs to be enforced, taxation on tobacco products needs to be increased and other provisions of the Framework Convention on Tobacco Control (FCTC) to which Nigeria signed in 2006 need to be enforced. Other interventions such as salt reduction policies, increased taxes on sugar-sweetened beverages, bans on trans-fats and a policy to enforce the reduction of saturated fatty acids needs to be developed. These policy measures are important to reduce the exposure to unfavourable risk factors at a population-wide level.
Our health services also need to be revamped and retooled from providing episodic one-time care for malaria and other infectious diseases and equipped to provide long-term chronic care of the kind that is needed to manage individuals with hypertension, high cholesterol and other cardiovascular risk factors who are at high risk. The concept of ongoing care to identify, monitor and treat risk factors as needed at the primary health care level is key as these conditions often remain undiagnosed and untreated until they result in often fatal consequences. To ensure that the largest number of Nigerians can access care regardless of their socioeconomic status, care needs to be provided at local health centres with the appropriate medications and equipment to diagnose, treat and monitor these conditions.
There is also a need to improve the acute care of cardiovascular conditions for people who present with heart attacks, strokes and other consequences of these conditions, including heart failure and dangerous heart rhythms. There is a critical need for a system of pre-hospital and emergency care, as prompt recognition and treatment of these conditions is often required for effective treatment. These systems are currently absent in Nigeria, irrespective of your status in society. Without a robust basic emergency care system as well as tertiary level care including necessary drugs and technology, coronary care units, cardiac catheterization labs, CT scans and stroke units, these conditions become almost universally fatal, in spite of good evidence for very effective interventions.
The lack of public awareness and health education on cardiovascular diseases and their risk factors remains a major issue. Recent data from an NOIPolls and EpiAFRIC poll conducted in 2014 showed a low awareness of cardiovascular diseases amongst a sample of Nigerians (52% were unaware of cardiovascular diseases), combined with a high proportion of those surveyed with hypertension, obesity and other conditions that increase the risks for heart disease and strokes.
There is a need to institute comprehensive health education to increase awareness of the major risk factors for heart disease and strokes and also to sensitize the population to the signs and symptoms of major cardiovascular disease. Do most hypertensives realize that they need their medications every day, and not just when their blood pressure is “high” or they have a “headache”? Can most people recognize chest pain or pressure radiating down the left arm with nausea or sweating as a potential heart attack? Can the average Nigerian recognize the signs and symptoms of a stroke? The need to increase awareness and advocacy for cardiovascular diseases is a critical link in addressing the burden.
So what can the average Nigerian do to reduce their risk of a heart attack or stroke? If you smoke, the time to quit is now. Smoking is one of the biggest modifiable risk factors for heart disease and stroke. We need to improve our diet by improving intake of fruits and vegetables and cutting down the intake of saturated fats, red meat and fried foods. If you are not exercising at least 30 minutes a day for at least 5 days of the week, your physical activity level is too low. Exercise does not always have to include a vigorous work-out at the gym, walking daily for at least 30 minutes counts towards exercise. Finally, for all adults over the age of 40 or younger if there is a history of heart disease in the family, know your numbers. Do you know your blood pressure? Do you know your cholesterol level? Have you been tested for diabetes? Do you know your cardiovascular risk? If you do not know these numbers, now is the time to visit your primary care provider to get this information and to follow-up ever year for updates.
Within these tragic stories, there is a chance to change the narrative. We can stop this disease from killing us at our prime but the time to act is now. Coach Keshi and Coach Amodu would have certainly wanted to make one last significant contribution to a nation to which they had already given so much.