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. 2018 Dec 26;13(12):e0208931.
doi: 10.1371/journal.pone.0208931. eCollection 2018.

Heart diseases and echocardiography in rural Tanzania: Occurrence, characteristics, and etiologies of underappreciated cardiac pathologies

Dominick M Raphael  1 , Laurine Roos  2 , Victor Myovela  1 , Elisante Mchomvu  1 , Jabir Namamba  1 , Said Kilindimo  3 , Winfrid Gingo  1 , Christoph Hatz  2   4 , Daniel H Paris  2   4 , Maja Weisser  2   4   5   6 , Richard Kobza  7 , Martin Rohacek  1   2   4   5
Affiliations

Heart diseases and echocardiography in rural Tanzania: Occurrence, characteristics, and etiologies of underappreciated cardiac pathologies

Dominick M Raphael et al. PLoS One. .

Abstract

Background: Little is known about heart diseases and their treatment in rural sub-Saharan Africa. This study aimed to describe the occurrence, characteristics, and etiologies of heart diseases, and the medication taken before and prescribed after echocardiography in a rural referral Hospital in Tanzania.

Methods: This prospective descriptive cohort study included all adults and children referred for echocardiography. Clinical and echocardiographic data were collated for analysis.

Results: From December 2015 to October 2017, a total of 1'243 echocardiograms were performed. A total of 815 adults and 59 children ≤15 years had abnormal echocardiographic findings; in adults 537/815 (66%) had hypertension, with 230/537(43%) on antihypertensive drugs, and 506/815 (62%) were not on regular cardiac medication; 346/815 (42%) had severe eccentric or concentric left ventricular hypertrophy, and 182/815 (22%) had severe systolic heart failure. Only 44% demonstrated normal left ventricular systolic function. The most frequent heart diseases were hypertensive heart disease (41%), valvular heart disease (18%), coronary heart disease (18%), peripartum cardiomyopathy (7%), and other non-hypertensive dilated cardiomyopathies (6%) in adults, and congenital heart disease (34%) in children. Following echocardiography, 802/815 (98%) adults and 40/59 (68%) children had an indication for cardiac medication, 70/815 (9%) and 2/59 (3%) for oral anticoagulation, and 35/815 (4%) and 23/59 (39%) for cardiac surgery, respectively.

Conclusion: Hypertension is the leading etiology of heart diseases in rural Tanzania. Most patients present with advanced stages of heart disease, and the majority are not treated before echocardiography. There is an urgent need for increased awareness, expertise and infrastructure to detect and treat hypertension and heart failure in rural Africa.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Distribution of heart diseases in adults (A) and in children (B). HD, heart disease; TB, tuberculosis.
Fig 2
Fig 2
Medication taken before and prescribed after echocardiography in adults (A) and in children (B).
See this image and copyright information in PMC

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Grants and funding

We received support from the following foundations: Symphasis Foundation, Zürich, Switzerland, Hella Langer Foundation, Gräfelfing, Germany, and Ernst Göhner Foundation, Zug, Switzerland to MR. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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