Heart Attacks on the rise in Nigeria: Can this be prevented?

While I was in medical school we were taught that heart attacks are rare in Nigeria. This

may explain why most of my classmates at one of the top medical schools were very poor

at reading Electrocardiograms (interpretation of the electrical activity of the heart over

time). Actually, to this day I remember a younger colleague’s decision to leave Nigeria

was spurred on by the inability of senior consultants to agree on an ECG reading. In fact,

basic ECG interpretation is quite simple for trained physician (even non-physicians) as

many Nigerian doctors who followed “Andrew” will attest to. Globally, all medical

school graduates are expected to be trained to interpret ECGs. Given the increase in

cardiovascular disease in Nigeria e.g. hypertension, strokes, and heart attacks, basic ECG

interpretation is a skill that every practicing physician needs to acquire. In a recent study

by Anadach Group in Lagos, 80% of physicians interviewed indicated that the number of

cardiac cases in their practices was rising.

In fact, it is increasing clear that Nigeria requires more expertise in Cardiology. Nigeria is

unfortunately caught in a double burden of cardiac disease and it is increasingly clear that

we require more expertise in Cardiology. Firstly, diseases of poverty and development

are still rampant – 1 in 10 children die before the age of 1 mostly from preventable causes

and the number of women who die from childbirth is equivalent to a planeload on a daily

basis (Source: Sandra Obiago from Communications For Change). Yet the prevalence of

chronic disease is rising, the number of Lagosians or other city dwellers with heart

attacks, strokes etc attest to this.

Cardiac disease usually affects people during their most productive phases and

consequently have significant impact on their families – a death in this age group could

throw a significant number of dependants into poverty. We all know a story or have a

relative who was doing very well and then became ill or died suddenly leaving behind a

family with no income. There are several predisposing factors to these cardiac diseases

and given the potential financial impact over the next decade on the country, the

government - both as the health regulator and one of the largest employers, and other

employers might wish to consider addressing. Such programs that address risk factors

could include – hypertension and diabetes screening, smoking cessation, increased

exercise and nutritional diet e.g. decreased red meat intake. At very reduced costs, these

proven public health strategies could reduce the future cardiac disease burden for

Nigeria.

In addition, there needs to be a drastic improvement in quality of cardiac treatment in

Nigeria. As several cardiac diseases are quite common among the upper strata of society,

it is actually quite shocking that there is very limited adequate modern treatment within

our borders. Yes, several rich Nigerians or senior government employees get sent to the

UK, US, South Africa and now India for cardiac treatment, but with an acute cardiac

incident like a heart attack – it would be difficult for an air ambulance to arrive on time.

Time after time, we hear of stories of people who get to hospitals with chest pain and die

on arrival in hospital or en route.

Basic cardiac support training is not widely up to date in many hospitals. Worse still

most people do not know what to do if they do get chest pain - a common symptom of a

heart attack. In the Anadach’s survey of upper middle class residents in Lagos only 23%

indicated they would go to the nearest heart facility while almost 70% indicated they

would go to their regular medical provider.

Several initiatives to address these deficiencies are ongoing – Dr. Yemi Johnson a US –

trained cardiologist is now practicing out of Lagos. He recently put in the first stent in

Nigeria (which has been widely used for cardiac treatment elsewhere for over 20 years)

and ANPA (Association of Nigerian Physicians in the Americas) has organized training

of trainers of Advanced Cardiac Life Support linked to selected teaching hospitals to help

embed this in our teaching hospital system.

But Nigeria has another resource which is not being leveraged enough - there at least 50

cardiologists of Nigerian origin in the US which could significantly complement the 100

or so cardiologists practicing in the country. India developed its health tourist industry

with significant input from Indian Physician Diaspora working with physicians and

industrialists in country. Given to the improved technology environment in the country,

we now have innovative ways to connect the Diaspora with in-country physicians. At

Anadach (www.anadach.com) we recently organized a webinar between the Minister of

State for Health and Diaspora Health Providers. Such methodology could be leveraged to

facilitate communication and knowledge transfer in other areas.

Given the immense public health challenges in Nigeria and the need for the government

to focus on addressing our embarrassingly high infant and child mortality rates, we

believe a significant amount of these solutions should come from the private sector,

building very much on the development of a health insurance system and the ability of a

significant chunk of Nigerians to pay. Decision makers and other rich Nigerians who

depend on international health care providers should remember, that with an acute heart

attack there would be insufficient time to arrange an air-ambulance from either South

Africa or Europe (and India is definitely out of the question).

But perhaps, even more importantly individuals and corporations need to take greater

responsibility for their health care especially for lifestyle diseases. Some advice to

ponder:

1) Don’t smoke. No amount of smoking is safe and even social smoking increases

your risk of a heart attack. Good news is once you quit smoking, risk of heart

disease starts to decline dramatically.

2) Get active – regular 30- 60 minutes intense physical activity most days of the

week. Remember housekeeping and climbing upstairs can add to the total – so

perhaps next time don’t send your child or house help upstairs for that book you

forgot – go get it yourself!

3) Eat heart- healthy diet (especially low in saturated and trans fat). Saturated fats

are high in beef and palm oil among others. Several studies indicate that richer

and urban Nigerians are more likely to be obese than poorer rural Nigerians

4) Maintain a healthy weight. Weight loss is especially important for people who

have large waist measurements - more than 40 inches (102 centimeters) for men

and more than 35 inches (88 cm) for women — because people with this body

shape are more likely to develop diabetes and heart disease.

5) Regular screening for Blood Pressure, Cholesterol and Diabetes especially if you

are over 40 or have a family history. Know your numbers!

6) Reduce Stress – Not sure how you can do this if you live in Lagos!!

Egbe thankful to the late Dr. David Hart, Dr. Enoma Alade and Dr. Emamuzo

Otobo for their help.