Africa-Press – Uganda. Figures from the World Heart Observatory, a global data platform run by the World Heart Federation, indicate that Uganda’s annual heart and circulatory disease deaths doubled in the last three decades.
The deaths increased from 14,463 to 28,149 between 1990 and 2019, according to our assessment of the data from the Observatory.
Scientifically known as cardiovascular diseases, heart and circulatory diseases, include a range of conditions such as coronary heart disease, heart attack, stroke, heart failure, rheumatic heart disease, and congenital heart disease.
Heart specialists say the rising deaths signal increasing risk factors and limited effectiveness of prevention strategies as the country experiences a rise in population, urbanisation, a sedentary lifestyle, and a shift in food preferences.
“Heart disease is the number one cause of death worldwide. High blood pressure and its complications is the most common [cause of] heart disease worldwide,” Dr Emmy Okello, a senior consultant cardiologist at Uganda Heart Institute (UHI) told this publication.
Dr Okello continued: “Number two is Rheumatic Heart Disease (RHD). Number three is diseases of heart muscles, also called cardiomyopathies. And then number four, you have congenital heart disease.”
Dr Tom Mwambu, another senior consultant cardiologist at the Institute, said it’s important to prevent CVDs because managing severe cases requiring surgery can cost over Shs20 million in East African countries.
He said that although some conditions like congenital heart disease might not be prevented, “the majority of the heart disease we are seeing now is acquired due to lifestyle change.”
This, the specialists who talked to this publication over the subject, prescribed at least nine ways Ugandans can minimise their risk of developing cardiovascular diseases and also living longer for those already affected.
Prevention
Take rest, avoid stress
“We should avoid so much stressful situations and try to get time to relax. Stress in many times may lead to high blood pressure and high blood pressure strains the heart a lot causing heart failure,” Dr Tom Mwambu, senior consultant cardiologist, said.
Dr Diana Atwine, the permanent secretary of the Ministry of Health advised people to develop the habit of being happy.
“Some people are full of stress and they frown all the time. Every time you are under stress, your body produces stress hormones that can make you get conditional high blood pressure. Those who know God should trust Him and feel nice. Just live a happy life, you don’t need to be very rich to live a happy life, even in your simple ways, just live a happy life,” Dr Atwine said.
However, Dr Kenneth Kalani, a psychiatrist at the Health Ministry, also said stress can be associated with realities such as economic hardships causing “hardship in accessing basic needs such as food and other social welfare such as paying school fees.”
Avoid being overweight
Dr Omagino said lack of physical activity and eating unhealthy diets –increase the chance of obesity which is a risk factor for CVD. He said they are concerned about the rising number of children who are overweight.
He advised schools to give time for physical exercise and regulate what children eat to minimize unhealthy foods that make them develop obesity. He also appealed to the government to close schools that don’t have space for physical exercise.
According to Dr Omagino, about 36 percent of children in schools are overweight. The recent Uganda Demographic and Health Survey report for 2022, also shows there is a rise in obesity in the general population from 17 percent to 26 percent in the last 17 years.
On prevention of CVDs, Dr Charles Oyoo Akiya, the commissioner for non-communicable disease prevention at the Ministry, called for modification of lifestyles and minimise stress levels.
He advised people to start “eating healthy foods, doing exercises for 30 minutes per day without necessarily going to gyms but instead within the comfort of your room including walking.”
Dr Elias Sebatta, another heart specialist at UHI, said: “Weight is also an issue where people who are obese are at much higher risks of getting high blood pressure and diabetes and this kind of obesity with so-called pot belly are more vulnerable.”
Stop smoking
Other than regulating salt consumption, Dr Mwambu said stopping tobacco smoking is essential.
“We should avoid smoking tobacco as well as taking alcohol because these are real risk factors for heart disease. Tobacco can cause you what we call a tobacco heart, which is a very big, weak heart. It can also cause abnormal metabolism of your fat, which can be deposited in the small blood vessels of the heart and end up with heart attacks,” he said.
Eat less salt
Dr Mwambu said excess salt will lead to high blood pressure. “And eventually your heart will not be able to pump. It will fail because it’s pumping against a very high resistance or a high pressure,” he added.
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To understand the level of salt consumption among Ugandans, researchers in 2014 and 2015 assessed 24-hour urine sodium levels as an index of dietary salt consumption among poststroke patients in Mulago Hospital with and without a history of hypertension in Uganda. Sodium is a component of salt.
The researchers noted that taking excess salt “increases risk of cardiovascular disease, hypertension, and premature death.”
They said they found that the “mean daily sodium excretion levels as assessed by 24-hour urine were high (more than 8.5 grams of sodium/day) in 65.0 percent versus 44.6 percent [of] cases [patients] and controls, respectively.”
“A majority (71.5 percent versus 57.1 percent) of poststroke cases and controls had urine sodium levels equivalent to a daily salt consumption in excess of the WHO recommendation of less than 5 grams /day salt,” the 2016 report by Dr Martin Kaddumukasa and colleagues reads.
Information from the WHO website indicates that the global health agency “recommends less than 2000 milligrams (or 2 grammes) per day of sodium (equivalent to less than 5 grams/day salt (just under a teaspoon).”
“For children aged 2–15 years, WHO recommends adjusting the adult dose downward based on their energy requirements,” the information from the global health agency reads further.
Avoid infections
Prof Nelson Sewankambo, who is a principal investigator in the Impact Training Program of Rheumatic Heart Disease (RHD) at Makerere’s College of Health Sciences, said the country is struggling with the burden of heart disease which is linked to bacterial infection.
“Rheumatic Heart Disease is due to a bacteria. Developed countries used to have RHD but it has gone down, they don’t see it. The disease can be prevented so that people don’t get the bacteria that causes it and the treatment is simple: it’s penicillin, a cheap medicine,” he said.
He said they are training health workers to detect and treat rheumatic fever which is the cause of RHD.
Dr Okello explained that the RHD starts as a bacterial infection.
“The bacteria is called Strep A. It’s common in children between five and 15 years. So, you know, children who are going to school, nursery and primary school, they’re sharing cups, they have flu,” he explains.
“This strep A bacteria which starts the process, spreads easily where children are overcrowded, malnourished, and when the houses they live in are poorly ventilated,” he added.
He observed that the infection usually manifests in a sore throat.
“Most times sore throat is caused by a virus. But in certain people, about half of them, it’s caused by bacteria. When they’re infected with bacteria, the body forms antibodies against the bacteria,” he explained.
Dr Okello continued: “But then because there are certain similarities between the wall of this bacteria and the body, there is some sort of collateral damage. The body sends antibodies against the bacteria, but ends up damaging its own tissues.”
“The most affected is the heart, and then the joints, and then the brain. So in a classical setting, you get a child who has early rheumatic fever. They have a fever, the joints are painful, and the child has behavioural changes because the thing is affecting the brain. Then over time, the heart valves get damaged and they start going into heart failure,” he added.
Watch your diet
“We should eat less fat and less sugar because excess sugar is converted into fat. Excess fat is going to block the vessels in your heart and give you heart attacks and cause many other problems,” Dr Mwambu advised.
According to information from the World Health Organisation (WHO), a healthy diet that reduces the risk of CVD is that which is full of vegetables and fruits, and has energy giving food and proteins.
The World Heart Federation (WHF) describes unhealthy diets as those foods “high in sugars, saturated fats (found in fatty cuts of meat, ice-cream, milkshakes, cakes); and trans-fats (which are found in deep fried foods like chicken, fish and chips), low fibre foods (highly refined flour) and high-sugar drinks.”
Avoid alcohol
On alcohol, Dr Mwambu said alcohol can also make the heart weaker. “Alcohol in itself is toxic. It is not very well known how exactly it causes the weakening of the heart. But there is a very high association between alcohol and heart disease,” he said.
Dr Hasfa Lukwata, the acting assistant commissioner for the mental health division at the Health ministry, said in terms of alcohol Uganda is “the highest in the region –Africa. For tobacco, we are seeing a tobacco reduction.”
Preventing heart defects in babies
Dr Mwambu said: “There are areas where it is very difficult for us to prevent. For example, congenital heart disease, sometimes we don’t know the exact cause. But we also know that there are a few drugs that a pregnant woman may take and they cause an abnormality in the child. But these are very few,” he said.
According to information from the United Kingdom’s National Health Service (NHS), Congenital heart disease is caused when something disrupts the normal development of the heart.
The agency said it is thought that most cases occur when “something affects the heart’s development during the first six weeks of pregnancy.”
The agency states since “there are several medicines linked to an increased risk of a baby being born with congenital heart disease”, one should speak to the doctor or pharmacist if they’re unsure about which medicines should be avoided during pregnancy.
Among the drugs highlighted by NHS as linked to increased risk of the condition are “certain anti-seizure medicines – such as benzodiazepines (for example diazepam); certain acne medicines – such as isotretinoin and topical retinoid; ibuprofen – women who take the painkiller ibuprofen when they are 30 or more weeks pregnant have an increased risk of having a baby with a heart problem.”
The NHS indicated that “paracetamol [such as Panadol] is a safer alternative to ibuprofen during pregnancy, although ideally, you should avoid taking any medicines while you’re pregnant, particularly during the first 3 months of pregnancy.”
Dr Sebatta also said late-age pregnancies have to be avoided because there high chances of having changes in genes and giving birth to children with congenital heart diseases.
“When there is a family history of heart disease especially when they get married within the same society you find that this disease keeps on increasing when both parents have the genes that have exposure,” he revealed.
Frequent health checks
Dr Omagino on the other hand advised the population to go for frequent health checks so that the disease can be detected early and reversed or treated.
“People are coming to the hospital when they are half-dead –their heart is already broken down, their vessels, kidneys, and brain are half dead,” he said.
Dr Sebatta on the other hand, said people with the conditions should consistently take the medication to prevent further complications.
“We should avoid people with heart problems getting into depression because they end up abandoning the medication and this puts their lives in danger because by the time they get back, you find that the problem has advanced,” he said.
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