**6. Effect of poverty on diagnosis treatment and control/eradication of CVD**

With the growing burden of NCDs worldwide, the 2011 United Nation (UN) high-level meeting adopted a political declaration on NCDs that aimed at a 25% reduction in premature mortality from the four main NCDs (cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes) by 25% relative to their 2010 levels by 2025 (the 25 × 25 target) [36]. In 2015, the UN SGD-3 was adopted to reduce by one-third premature mortality from NCDs by 2030 [17]. To realise

**21**

*Poverty and Cardiovascular Diseases in Sub-Saharan Africa*

the SGD-3 target on health, a reduction in tobacco use, harmful alcohol use, salt intake, obesity, raised blood pressure, increased blood glucose and diabetes, and physical inactivity is essential [56]. Besides, treating people at high risk of CVD and ensuring a sustainable availability of medicines to treat NCDs and avoid potential complications is also critical [56]. The above measures are challenging to implement because of the regional poverty, underfunded healthcare systems and the absence of clear policies and strategies [57]. To overcome these challenges, governments and other key stakeholder groups need to instigate several measures that may reduce CVD morbidity and mortality, especially among the poor. These include researching to assess the optimal way to help diagnose CVD early and educate patients of the benefits of biomedical versus traditional medical approaches alongside lifestyle changes. In cognisance of the high levels of illiteracy among many of these patients, approaches such as pictograms are helpful in enhancing understanding [36, 58]. In addition, for governments to produce up-to-date guidelines that are robust and easy to use in electronic formats, with regular monitoring of prescribing patterns to improve the future quality of prescribing [59, 60]. This recognises that adherence to prescribing guidelines is seen as a better marker of the quality of prescribing than current WHO/INRUD criteria [61]. Alongside this, seek to instigate policies to enhance access to low-cost medicines, thereby reducing costly co-payments. This can potentially be achieved with the help of donors and pharmaceutical companies and exploring the potential for local manufacturing of multiple sourced medicines building on concerns during the COVID-19 pandemic [61]. In the meantime, exploration of the potential for aggressive procurement programmes since we have seen in Europe that such programmes have resulted in the prices of generic medicines used to manage CVD as low as 2% of pre-patent prices [62]. Issues of transport costs to clinics to effectively treat patients with CVD also needs to be researched further as lack of contact can be a significant barrier to adherence to medicines for NCDs [63]. In addition, exploring different methods to improve the convenience of medicine dispensing that reduces time off work building on current initiatives in

There are concerns about the rising burden of CVD in SSA, adding to the prevalent infectious diseases in the region. The increase in CVD is due to behavioural and metabolic risk factors resulting from the epidemiologic transition in the region. The intersection between poverty and CVD cuts through primordial, primary prevention and secondary prevention interventions. In the context of poverty in SSA, CVD prevention is a challenge due to competing demands to address the never conquered infectious diseases. With a weak healthcare system and out of pocket payment for the costs of CVD care, a significant proportion of individuals with CVD and their households are pushed into poverty. Besides, CVD affects a younger and productive

Consequently, CVD-related loss of productivity will push an additional number of individuals into poverty. Because of this, appropriate strategies are needed to address the rising burden of CVD across SSA, and these should include activities to address poverty issues. Activities include providing available funding and resources for effective screening for NCDs, especially CVD and diabetes, given high rates of patients not being diagnosed. Alongside this, improving the access and availability of medicines, especially where co-payments are an appreciable issue among patients. Multiple channels exist, including activities of donors as well as increasing local production. Alongside this, enhance educational input, especially

*DOI: http://dx.doi.org/10.5772/intechopen.98575*

South Africa and wider [27].

population in SSA than in the rest of the world.

**7. Conclusions**

#### *Poverty and Cardiovascular Diseases in Sub-Saharan Africa DOI: http://dx.doi.org/10.5772/intechopen.98575*

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

crucial in reducing the overall burden and complications of RHD [44].

**4. The effect of CVD on poverty in Africa**

and an appreciable cause of premature mortality with a mean age of death as low as 25 years [43]. While medical and surgical management can reduce morbidity and mortality, poverty reduction and improvement of overall living standards are

CVDs occur approximately two decades earlier in SSA than in the rest of the world [5]. In the context of poverty and weak healthcare systems, patients with CVD in SSA have higher all-cause mortality and shorter lifespans than in the other parts of the world due to often limited access to healthcare. Over 50% of these patients die between 30 and 69 years of age, approximately ten years or more below the equivalent group in higher-income countries [45]. Consequently, death and disability attributable to CVD occur in the middle and economically productive age, affecting young families and the much-needed workforce in the region [45, 46]. Available evidence implicates stroke as the cause of the majority of CVD-related mortality in SSA [46]. With the absence of universal health coverage and robust health insurance systems among most SSA countries, patients and their families bear the costs of CVD care costs [47]. In some instances, patients forego treatment due to costs [47]. The impoverishing effect of out-of-pocket payments is increasingly pushing many individuals and families into poverty with family members affected by CVD [6].

**5. Poverty, illiteracy, and indigenous knowledge system effect on CVD**

**6. Effect of poverty on diagnosis treatment and control/eradication** 

With the growing burden of NCDs worldwide, the 2011 United Nation (UN) high-level meeting adopted a political declaration on NCDs that aimed at a 25% reduction in premature mortality from the four main NCDs (cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes) by 25% relative to their 2010 levels by 2025 (the 25 × 25 target) [36]. In 2015, the UN SGD-3 was adopted to reduce by one-third premature mortality from NCDs by 2030 [17]. To realise

Given the high cost and inaccessibility of biomedical care and medications for CVD, traditional healers are central to CVD treatment among patients in SSA [48, 49]. The spiritual underpinning of chronic diseases such as CVD, cultural beliefs, and taboos are reasons behind the preference of traditional healers over biomedicine as the first choice in some parts of SSA [50]. Consequently, it is not uncommon for individuals in the region to seek help from traditional healers to treat diabetes, hypertension, and stroke [51–53]. The belief that traditional healers are experts in treating and curing CVDs and their risk factors delays the transfer to biomedical care despite the clinical deterioration in some patients [50]. Those who transfer to biomedical care are less likely to maintain treatment compliance equivalent to traditional medicines. These culturally driven practices present the greatest threat to the treatment and control of CVDs and their risk factors [50]. Some cultural ideas partly explain the persistently low knowledge of CVDs, risk factors, and clinical symptoms in the SSA population [54]. Therefore, governments and other key stakeholder groups understanding these cultural-driven beliefs and practices are essential in devising strategies to improve health literacy in

**20**

**of CVD**

managing and controlling CVDs [55].

the SGD-3 target on health, a reduction in tobacco use, harmful alcohol use, salt intake, obesity, raised blood pressure, increased blood glucose and diabetes, and physical inactivity is essential [56]. Besides, treating people at high risk of CVD and ensuring a sustainable availability of medicines to treat NCDs and avoid potential complications is also critical [56]. The above measures are challenging to implement because of the regional poverty, underfunded healthcare systems and the absence of clear policies and strategies [57]. To overcome these challenges, governments and other key stakeholder groups need to instigate several measures that may reduce CVD morbidity and mortality, especially among the poor. These include researching to assess the optimal way to help diagnose CVD early and educate patients of the benefits of biomedical versus traditional medical approaches alongside lifestyle changes. In cognisance of the high levels of illiteracy among many of these patients, approaches such as pictograms are helpful in enhancing understanding [36, 58]. In addition, for governments to produce up-to-date guidelines that are robust and easy to use in electronic formats, with regular monitoring of prescribing patterns to improve the future quality of prescribing [59, 60]. This recognises that adherence to prescribing guidelines is seen as a better marker of the quality of prescribing than current WHO/INRUD criteria [61]. Alongside this, seek to instigate policies to enhance access to low-cost medicines, thereby reducing costly co-payments. This can potentially be achieved with the help of donors and pharmaceutical companies and exploring the potential for local manufacturing of multiple sourced medicines building on concerns during the COVID-19 pandemic [61]. In the meantime, exploration of the potential for aggressive procurement programmes since we have seen in Europe that such programmes have resulted in the prices of generic medicines used to manage CVD as low as 2% of pre-patent prices [62]. Issues of transport costs to clinics to effectively treat patients with CVD also needs to be researched further as lack of contact can be a significant barrier to adherence to medicines for NCDs [63]. In addition, exploring different methods to improve the convenience of medicine dispensing that reduces time off work building on current initiatives in South Africa and wider [27].
