EDITORIAL

Abdominal aortic aneurysm—The African experience

Lily Wu

Vascular Unit, Department of Surgery, University of Ghana Medical School, Accra. Ghana

*Correspondence Address:
Dr. Lily Wu Vascular Unit, Department of Surgery, University of Ghana Medical School, Accra.
Source of grant: None
Conflict of Interest: None

About one-third of the whole world’s disease burden is due to surgical conditions. Globally, in 2010, there were 52.8 million deaths. Deaths from non-communicable diseases including surgical conditions increased by close to 8 million people between 1990 and 2010. This represents two out of every three deaths globally.[1],[2],[3] Despite this high global mortality rate, there has been improvement in global health. However, mortality from non-communicable diseases and surgical conditions including abdominal aortic aneurysm (AAA) remains high in low- and middle-income countries in Africa.[1] The general worsening epidemiological pattern of non-communicable diseases in Africa notwithstanding, huge regional variations exist when comparing data from high-income and middle/low-income countries. This may partly be due to the slow progress in the expansion of health facilities and underdevelopment of safe surgical and anaesthesia specialty.[1]

AAA is a surgical condition associated with high morbidity and mortality even in the high-income countries. In this issue of the journal, Ngetich et al. in a systematic review of AAA in Africa have reported a prevalence of between 0.7% and 6.4%, with a wide age range and most of the patients being male. Most cases were identified incidentally, and about one-third presented with rupture. AAA rupture in particular is associated with very high mortality, 50% or more.[4] The aetiology of AAA is mainly degenerative, which reflects in its age predilection among those above 70 years, particularly in high-income countries.[5] AAA found in younger people is mainly due to infective causes, especially human immunodeficiency virus (HIV), another global disease with a high prevalence in Africa.[6],[7],[8],[9],[10] Despite the increasing life expectancy in Africa, the high burden of HIV and other infectious diseases may account for the high prevalence of aortic aneurysm among young people in Africa.[11],[12],[13] Other known risk factors are smoking, hypertension, and hyperlipidemia.[10]

Even though some literature suggests a decline in ruptured AAA admission, emergency AAA repair, and AAA mortality across all age groups in some developed countries,[14],[15] the reverse is true in developing countries.[16],[17]

Data on the prevalence of AAA in Africa are scanty. The paucity of data is predominantly a problem in West and East Africa. Relatively, a lot of work with respect to AAA has been done in northern and southern African countries. There are also no screening services for AAA available in Africa for high-risk populations. Until recently (after 2015), there were no trained specialist vascular surgeons available in West and East Africa even though northern and southern African countries have had trained and skilled vascular surgeons for over two decades.

This regional heterogeneity, coupled with limited access to and disproportionate distribution of health facilities, and unavailable or poor national health insurance schemes to make treatment accessible and affordable, calls for a concerted effort in the subregion geared towards more research focused on AAA in particular to inform health policy modification to combat this emerging menace.

Unfortunately, infectious diseases (communicable diseases) still account for the highest proportion of annual all-cause mortality in sub-Saharan Africa.[1] This impedes attempts at health policy transition in favour of non-communicable diseases in terms of research funding, manpower training and personnel specialization, and adequate provision of health facilities and equipment. To contain and curb the rising burden of AAA in Africa, there is the need for sound epidemiological assessment through research to determine the true prevalence of AAA in Africa and find the reasons accounting for the regional variation in the prevalence and the relatively higher mortality of AAA in the continent. It is also necessary to identify high-risk populations with the aim of instituting screening services for such groups and initiate health policy debate to redirect governments’ attention to and support for dealing with this deadly disease.

In the meantime, health personnel education on AAA to raise awareness, and development of diagnostic algorithms and treatment protocols may facilitate prompt and accurate diagnosis of patients with AAA. Accelerated national drive to select and train specialists, and cost-effective and timely treatment of AAA with deployment of safer and newer alternative surgical remedies are highly recommended.

[TAG:2][/TAG:2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References