One out of 10 of the half billion people in subSaharan Africa is dying from cardiovascular disease. Their plight seems to go unnoticed by local governments and international relief agencies who are preoccupied with the AIDS crisis.
A picture of neglect, with one out of eight people - a large number of them children - suffering from rheumatic heart disease was painted by African cardiologists and international physicians at a recent meeting of the European Society of Cardiology (ESC) in Amsterdam. Another 10 to 20 per cent of the subSaharan population - as many as 10 million people in Nigeria alone - are beset with dangerously elevated high blood pressures that lead to heavy rates of haemorrhagic strokes.
In the sprawling cities of Africa, where cigarette smoking, familial dislocation and fatty Western diets are on the rise, rates of hypertension are rapidly becoming doubled, reported Dr Walinjom Muna, president of the Pan African Society of Cardiology.
"While we in Europe are fighting for minute improvements in existing therapy, and often increasing the cost of care unreasonably in these pursuits, there are things happening around us that are very much more important," Lars Ryden, president of the ESC, warned at the opening of the first international medical meeting devoted to heart disease in Africa.
"The AIDS epidemic has taken the wind out of the treatment of non-communicable diseases like hypertension, along with some of the momentum we had going in trying to get the policy-makers to listen to us," said Dr Muna, who is chairman of the department of medicine at the University of Yaounde in Cameroon.
In a region where the average life span is 47 years - and as low as 27 in AIDS-and warfare-wracked Sierra Leone - Dr Muna said it was hard to get authorities to focus on the withering long-term impact of high blood pressure.
But impassioned audience members pointed out that this condition can be controlled with generic drugs that cost as little as three to five pence a day.
Cardiologist Dr Edmond Bertrand of Marseille, who spent 30 years working in the Ivory Coast and Cameroon, noted that huge numbers of African children are also suffering from the staph infection-borne rheumatic fever which often leads to a gross swelling of the heart's pumping chambers and death at an early age. The root organism is spread through poor sanitation, overcrowded housing and sexual promiscuity, he said.
In norther Africa, as much as 40 per cent of the population now has rheumatic heart disease. Although the incidence drops off closer to the Equator, the subSaharan young are disproportionately afflicted. A quarter of those with rheumatic heart disease are under 15. Of those who make it to hospital, 95 per cent already have dangerously swollen hearts; 60 per cent have the full-blown congestive heart failure that typically afflicts Europeans at a much older age. So deep are the health problems of the continent that even Dr Bertrand's simple plea provoked controversy, with some remonstrating that emergency room valve surgery is pointless in a region where only three of 48 countries have any open-heart programmes at all.
Dr Tony Golby of Johannesburg, South Africa, responded: "I do not believe that the politicians, the economists, the third-party payers can force us to stop treating patients, especially when they're children - no matter what the global view is - at the expense of saying we can do more with prevention".
Sweden's Dr Ryden, a board member of the World Health Organisation (WHO), which sponsored the symposium, countered that only massive regional public health initiatives could restrain the growing dimensions of the cardiovascular disease problem in Africa. He promised that the WHO and other international bodies were determined to bring increased focus to the problem.
"There is no doubt in anybody's mind that none of the subSaharan African countries can afford to treat cardiovascular diseases and that is the urgent reason why we must do everything possible to prevent an epidemic from spreading before it is too late," added Dr George Mensah, of the Cardiovascular Health Branch of the US Centers for Disease Control in Atlanta, Georgia.