**2.2 Cardiovascular risk factors: rural versus urban environment**

Several African studies have indicated a higher prevalence of FDRCV in urban areas than in rural areas and attributed this disparity to lifestyle change in urban areas. The most documented RFs are hypertension, diabetes, obesity, and high cholesterol.

The prevalence of hypertension is very high in SSA. It varies according to the studies and according to the regions globally between 19 and 43% in the general population and can exceed 70% beyond 65 years; it is higher in urban areas than in rural areas [7–9]. Studies carried out across a few African countries have shown

> some prevalence figures: 19.3% and 21.4% respectively in Nigeria and Kenya in rural areas, 23.7% and 38% in Tanzania and Namibia in urban areas [10]. In South Africa, 43% in rural areas, 77.3% in subjects aged over 50 in urban areas [10]. In Benin, the prevalence of high blood pressure, obesity and diabetes has been higher in urban than in rural areas, while, exceptionally, that of smoking has been higher in

*respectively, followed by pulmonary embolism (2,7%) and ischemic cardiopathy (2,25%).*

*Proportions of Death from Different CVDs. Source: Statistics from the National Cardiovascular Disease Control Program, PNMCV / DR Congo, 2018. This figure indicates that stroke and all-cause heart failure were the two leading causes of cardiovascular mortality in Kinshasa hospitals between 2007 and 2016, with 55.7% and 23%*

*Lifestyle and Cardiovascular Risk Factors: Urban Population versus Rural Population…*

*DOI: http://dx.doi.org/10.5772/intechopen.96881*

particular the dietary habits with different salt intake levels.

sity, ie more prevalent in urban areas than in rural areas [7].

**2.3 Lifestyle in rural versus urban areas**

The disparity in hypertension prevalence rates between the different SSA countries is probably linked, beyond the methodology and the conditions for carrying out each study, to the socio-cultural characteristics of each society, including in

At the African level, a meta-analysis of SSA carried out in 2007 [12] indicated that diabetes was the second cardiovascular risk factor. Its prevalence is higher in urban areas than in rural areas. This is the case in the Democratic Republic of Congo, where prevalences of 4.8% and 25% were observed in rural and urban areas

The prevalence of obesity is steadily increasing in large cities in SSA, mainly due to the new lifestyle imposed by urbanization. Thereby, the prevalence of obesity is higher in urban than in rural areas and is estimated at over 60% in some regions [10]. In SSA, hypercholesterolemia follows the same geographic distribution as obe-

In DR Congo, there has been a gradual increase in the prevalence of hypertension over the years, in view of certain surveys carried out mainly in the capital, from 9.9% in 1986 to 26% in 2018 [14–16]; Unfortunately, there is no large-scale survey, in the general population, comparing the burden of CVRFs in rural versus urban areas.

According to World Bank data, more than 50% of the population in SSA lives in rural areas, which is characterized by the predominance of traditional economic and social survival activities: agriculture, animal husbandry and fishing. As these

rural areas [11].

**Figure 2.**

respectively [13].

**169**


*Source: Statistics from the National Cardiovascular Disease Control Program, PNMCV / DR. Congo, 2018. This table shows that CVDs represent 31.1% of all hospitalizations in the medical sector in Kinshasa hospitals between 2007 and 2016; Stroke is the leading cause of morbidity in hospitalization in the medicine sector with 53% of cardiovascular morbidity and 16.6% of overall morbidity, followed far behind by heart failure and ischemic heart disease. We can also observe the low frequency of heart valve disease (including rheumatic valve disease), probably due to the easier access to antibiotics and other preventive measures, mainly in urban areas.*

*The table indicates also that CVDs represent in Kinshasa hospitals, between 2007 and 2016, 35.4% of overall mortality in the medicine sector; stroke accounts for 55.7% of cardiovascular mortality and 19.7% of overall mortality, followed by pulmonary embolism and ischemic heart disease.*

*These results on hospital morbidity and mortality in Kinshasa join those of a hospital survey carried out more than twenty years ago in a hospital establishment in Kinshasa, where stroke represented 31% of cardiovascular morbidity, 6% of morbidity overall, 57% of cardiovascular mortality and 12% of overall mortality [6].*

#### **Table 2.**

*Cardiovascular morbidity and mortality from 2007 to 2016 in eight hospitals in Kinshasa, DR Congo.*

*Lifestyle and Cardiovascular Risk Factors: Urban Population versus Rural Population… DOI: http://dx.doi.org/10.5772/intechopen.96881*

#### **Figure 2.**

cardiomyopathy and coronary heart disease. In addition, rheumatic heart disease

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

The **Tables 1** and **2** and **Figures 1** and **2** below relating to cardiovascular morbidity and mortality in SSA clearly illustrate the current place occupied by CVDs in

There are also a number of underlying determinants of CVDs. They stem from major social, economic and cultural developments - globalization, urbanization, aging populations, poverty, stress and hereditary factors [3]. It is these sociocultural and economic disturbances that could partly determine the differences

Several African studies have indicated a higher prevalence of FDRCV in urban areas than in rural areas and attributed this disparity to lifestyle change in urban areas. The most documented RFs are hypertension, diabetes, obesity, and high

The prevalence of hypertension is very high in SSA. It varies according to the studies and according to the regions globally between 19 and 43% in the general population and can exceed 70% beyond 65 years; it is higher in urban areas than in rural areas [7–9]. Studies carried out across a few African countries have shown

**n%n%**

**CVDs Morbidity Mortality**

*due to the easier access to antibiotics and other preventive measures, mainly in urban areas.*

*6% of morbidity overall, 57% of cardiovascular mortality and 12% of overall mortality [6].*

*followed by pulmonary embolism and ischemic heart disease.*

**Table 2.**

**168**

*The table indicates also that CVDs represent in Kinshasa hospitals, between 2007 and 2016, 35.4% of overall mortality in the medicine sector; stroke accounts for 55.7% of cardiovascular mortality and 19.7% of overall mortality,*

*These results on hospital morbidity and mortality in Kinshasa join those of a hospital survey carried out more than twenty years ago in a hospital establishment in Kinshasa, where stroke represented 31% of cardiovascular morbidity,*

*Cardiovascular morbidity and mortality from 2007 to 2016 in eight hospitals in Kinshasa, DR Congo.*

Stroke **10367** 16,57 **2124** 19,68 Heart failure **5477** 8,76 **876** 8,12 Ischemic cardiopathy **501** 0,80 **86** 0,80 Pulmonary embolism **278** 0,44 **103** 0,95 Deep vein thrombosis **246** 0,39 — — Pericarditis **81** 0,13 **13** 0,12 Valvular heart diseases **79** 0,13 **12** 0,11 Bacterial endocarditis **6** 0,01 **2** 0,02 Acute articular rhumatism **13** 0,02 **1** 0,01 Other **2432** 3,89 **597** 5,53 All CVDs. **19480 31,14 3814** 35,35 All internal medicine diseases **62553 100,00 10790** 100,00 *Source: Statistics from the National Cardiovascular Disease Control Program, PNMCV / DR. Congo, 2018. This table shows that CVDs represent 31.1% of all hospitalizations in the medical sector in Kinshasa hospitals between 2007 and 2016; Stroke is the leading cause of morbidity in hospitalization in the medicine sector with 53% of cardiovascular morbidity and 16.6% of overall morbidity, followed far behind by heart failure and ischemic heart disease. We can also observe the low frequency of heart valve disease (including rheumatic valve disease), probably*

remains a worrying problem [5].

observed between rural and urban areas in Africa.

**2.2 Cardiovascular risk factors: rural versus urban environment**

this region of the world.

cholesterol.

*Proportions of Death from Different CVDs. Source: Statistics from the National Cardiovascular Disease Control Program, PNMCV / DR Congo, 2018. This figure indicates that stroke and all-cause heart failure were the two leading causes of cardiovascular mortality in Kinshasa hospitals between 2007 and 2016, with 55.7% and 23% respectively, followed by pulmonary embolism (2,7%) and ischemic cardiopathy (2,25%).*

some prevalence figures: 19.3% and 21.4% respectively in Nigeria and Kenya in rural areas, 23.7% and 38% in Tanzania and Namibia in urban areas [10]. In South Africa, 43% in rural areas, 77.3% in subjects aged over 50 in urban areas [10]. In Benin, the prevalence of high blood pressure, obesity and diabetes has been higher in urban than in rural areas, while, exceptionally, that of smoking has been higher in rural areas [11].

The disparity in hypertension prevalence rates between the different SSA countries is probably linked, beyond the methodology and the conditions for carrying out each study, to the socio-cultural characteristics of each society, including in particular the dietary habits with different salt intake levels.

At the African level, a meta-analysis of SSA carried out in 2007 [12] indicated that diabetes was the second cardiovascular risk factor. Its prevalence is higher in urban areas than in rural areas. This is the case in the Democratic Republic of Congo, where prevalences of 4.8% and 25% were observed in rural and urban areas respectively [13].

The prevalence of obesity is steadily increasing in large cities in SSA, mainly due to the new lifestyle imposed by urbanization. Thereby, the prevalence of obesity is higher in urban than in rural areas and is estimated at over 60% in some regions [10].

In SSA, hypercholesterolemia follows the same geographic distribution as obesity, ie more prevalent in urban areas than in rural areas [7].

In DR Congo, there has been a gradual increase in the prevalence of hypertension over the years, in view of certain surveys carried out mainly in the capital, from 9.9% in 1986 to 26% in 2018 [14–16]; Unfortunately, there is no large-scale survey, in the general population, comparing the burden of CVRFs in rural versus urban areas.

#### **2.3 Lifestyle in rural versus urban areas**

According to World Bank data, more than 50% of the population in SSA lives in rural areas, which is characterized by the predominance of traditional economic and social survival activities: agriculture, animal husbandry and fishing. As these

activities have not been modernized, they are essentially carried out by hand and thus require their providers to have a high, regular and permanent level of physical activity. In addition, the diet contains fewer processed products than in urban areas. All this could explain the low prevalence of CVRFs in comparison to the urban environment where we find the following characteristics: tendency to sedentary lifestyle, insufficient physical activity, diet high in sugar, fat and salt, stress psychosocial etc.

• the stage of decline in pandemics, leading to an improvement in life

*Lifestyle and Cardiovascular Risk Factors: Urban Population versus Rural Population…*

• the stage of the reign of chronic diseases or NCDs, a consequence of the

This concept was supplemented by that of health transition [20], which is more global, encompassing not only the epidemiological situation but also the different

Conversely, the urban and peri-urban environment in SSA are characterized by

There is growing evidence that poverty promotes NCDs, particularly through poor accessibility to treatment [24] and other health services; in low-income countries, the high prevalence of RDF of NCDs, the early onset of their complications [25–29] as well as the excess mortality associated with these diseases constitute strong arguments in favor of this link between poverty and NCDs. The following statement by Ambassador Taonga Mushayavanhu, Permanent Representative of the Republic of Zimbabwe to the United Nations Office at Geneva, within the framework of the "Dialogue on NCDs, Poverty and Development Cooperation" forum is

"In developed countries, the population often takes advantage of multisectoral policies and plans put in place by the government to reduce exposure to risk factors and empower health systems", explains the Ambassador, who adds: "Developing countries have little capacity to fight NCDs, which leads to premature death, reduces productivity, slows economic growth and locks the most destitute in chronic poverty. In a report published in April 2013, the African Union pointed out that the exorbitant costs associated with NCDs push 100 million people into poverty each year, hampering development. Yet the tools, knowledge and strategies avail-

It should be recalled that NCDs have already been the subject of three high-level meetings at the United Nations, in 2011, 2014 and 2018, each time bringing together the various member states of the world organization at the highest level of representation. World leaders have recognized that NCDs pose the greatest threat to health and development worldwide, especially in the developing countries. To this end, a political declaration on NCDs was adopted at the first high-level meeting. At the Sixty-sixth World Health Assembly held in May 2013 and as part of the follow-up to the Political Declaration of the First High-Level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable

Diseases, States approved the Global Plan of Action for the Control of

1.To raise the priority accorded to the prevention and control of

Noncommunicable Diseases for 2013–2020 [17], whose objectives and voluntary

noncommunicable diseases in global, regional and national agendas and

a tendency to sedentary lifestyle, a diet rich in sodium and calories, excessive alcohol consumption, socio-professional stress, all this in a context of poverty or social insecurity. Linked in particular to an uncontrolled rural exodus. This results in an increase in biological or physiological RFs [15, 21, 22] and a vicious circle between NCDs which exacerbate poverty and vice versa, poverty which promotes NCDs [23], poverty understood in the classic World Bank sense, namely an income of less than \$ 1.9 per day per person or the inability to afford basic minimum

expectancy;

services.

increase in life expectancy.

*DOI: http://dx.doi.org/10.5772/intechopen.96881*

responses from society to health issues.

sufficiently enlightening on the question:

global targets are as follows.

**3.1 Objectives**

**171**

able today can prevent most of these diseases" [23].

Hence the interest of general measures among populations as recommended by the WHO, including reducing salt consumption. In fact, in the 2013–2020 global action plan to combat NCDs [17] adopted in 2013, one of the targets to be achieved by 2025 was the 30% reduction in average salt consumption by populations to reduce the prevalence of hypertension. The effective implementation of this recommendation requires general measures, among the populations, aimed at reducing salt consumption, in particular by discouraging the use of added salt during food preparation or at the table.

It is also useful to mention that locking rural populations in an environment dominated by traditional mores and mentalities can constitute a handicap to understanding and adopting new behaviors necessary for the fight against NCDs. This can make rural populations fragile once they are exposed to NCD RFs. This is precisely what is observed among populations from rural areas and living in periurban areas, mentally close to their traditional areas but confronted with a Westerntype society that exposes them to the RFs of NCDs. An awareness-raising effort for the fight against NCDs, adapted to each environment and each social category, deserves to be encouraged.
